Manager HEDIS Program (HEDIS Subject Matter Expert) - Remote

Manager, HEDIS Program

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary : The Manager, HEDIS Program educates and serves as the HEDIS subject matter expert (SME). The Manager, HEDIS Program is responsible for coordinating, implementing, and executing HEDIS Program specific projects, and ensuring consistency with company strategy, commitments, and goals. The HEDIS Administrator will assist with the communication of HEDIS results to internal and external stakeholders and coordinate efforts to drive improvements through quality improvement interventions (QIIs) projects (QIPs) across the health plan.

Job Description Key Outcomes :

• Manages the HEDIS Program including requirement gathering, creation of project plans and schedules, obtaining and managing resources, facilitating project execution, deployment, and closure.
• Stays current with HEDIS guidelines and requirements, and best practices related to the execution of the HEDIS Roadmap.
• Prepares accurate and timely reports on HEDIS performance for internal and external stakeholders, management, and regulatory bodies.
• Maintains detailed project documentation in accordance with the NCQA HEDIS technical specifications, and HEDIS compliance audit standards, policies, and procedures.
• Develops and implements strategies to validate supplemental data sources used in HEDIS operations, ensuring accuracy and reliability.
• Works closely with vendors to ensure accuracy and validity of data obtained from external sources.
• Creates and maintains a tracking system to document records of annual primary source verification activities, ensuring compliance with regulatory requirements.
• Maintains a robust medical record review program to assess the quality of care provided by healthcare providers.
• Develops and implements comprehensive auditing procedures to evaluate the accuracy and completeness of medical record documentation.
• Analyzes medical record review findings and identifies opportunities for process improvement.
• Manages the HEDIS team including coaching, professional growth and development, conducting performance evaluations and providing regular feedback to team members.

Education / Experience :

Required License(s) and / or Certification(s) :

Skills / Knowledge / Competencies (Behaviors) :

This position is not eligible for immigration sponsorship. We are an equal opportunity / affirmative action employer. Do you have a question about careers at Martin's Point Health Care? Contact us at : jobinquiries@martinspoint.org