HEDIS Manager Performance Improvement (Remote Eligible)

About the position Now hiring a Manager-Performance Improvement! Presbyterian Healthcare is hiring a Manager-Performance Improvement. The Manager, Performance Improvement has overall responsibility for managing the daily operations of HEDIS/Star Quality and Regulatory reporting within the Performance Improvement Department. This key position works in collaboration with a variety of entities, departments, administration, and leadership bodies to ensure organizational improvement efforts align with accrediting, licensing, and legal requirements. This position provides program management and subject matter expertise for complex analytics and reporting in support of the annual HEDIS submission for Managed Care Organizations (MCOs), Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance. This position collaborates with the Director of Performance Improvement, the HEDIS contracted Vendor, and the Analytics Operations department to ensure timely and accurate reporting to meet accreditation and regulatory requirements, and performance measure targets. Responsibilities • In collaboration with Director of Performance Improvement and Senior Leadership, determines an approach to securing and maintaining an annual Medicare Advantage Star Rating of 4.0 or higher, meeting 100% of Medicaid Performance Measure targets as established by New Mexico Health Care Authority (HCA) and other States, and ensuring the maintenance of NCQA health plan accreditation for all lines of business. • Works with Director of Performance Improvement to provide direction, coordination, implementation, execution, and completion of HEDIS and Medicare Star programs ensuring consistency with accreditation and regulatory requirements, along with company strategy, commitments, and goals. • Provides subject matter expertise in HEDIS and CMS STARS and assures continual performance improvement in QA / QI activities while furthering the vision, values and strategies of Presbyterian Healthcare Services (PHS). • Promotes PHS Quality strategies and compliance with policies and standards, adopted accreditation standards and federal / state regulatory requirements. Requirements • Bachelors degree in Business, Healthcare, or related field required. 6 years of additional experience can be substituted in lieu of a degree. • Minimum of five years in healthcare/managed care industry with experience in HEDIS/Medicare Star performance measurement, analytics, reporting, and forecasting required. • Two years of prior supervisory or program/project manager experience required. • Experience presenting to leadership teams, clinicians, and employer groups also required. Nice-to-haves • Five years working in the healthcare field. • Two years of experience in HEDIS and CMS STARS regulatory submissions. • Two years of supervisor/manager experience in a healthcare setting. • Master's degree in health related or business administration field (i.e., public health, health care administration). • Intermediate/advanced skills in Microsoft Office. Benefits • Comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. • Wellness program designed to provide engaging opportunities to enhance health and activate well-being. Apply tot his job