HEDIS Manager Performance Improvement

Now hiring a ManagerPerformance Improvement!

Presbyterian Healthcare is hiring a ManagerPerformance 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.
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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.

How you belong matters here.

We value our employees differences and find strength in the diversity of our team and community.

At Presbyterian its not just what we do that matters. Its how we do it and it starts with our incredible team. From Information Technology to Food Services and beyond our nonclinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time Exempt: Yes
• Remote work from home: This job is intended to be conducted in the state of New Mexico.
• Remote work from home: this job is intended to be conducting in the state of New Mexico.
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical wellness program vision dental paid time off retirement and more for FT employees.

Prefer Qualifications

• 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
• Masters degree in health related or business administration field (i.e. public health health care administration)
• Intermediate/advanced skills in Microsoft Office

• Bachelors degree in Business Healthcare or related field required. 6 years of additional experience can be substituted in lieu of a degree. Master s degree preferred.
  
  
• 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.

• 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 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
  
  

All benefitseligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision shortterm and longterm disability group term life insurance and other optional voluntary benefits.

Wellness
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your wellbeing. Earn gift cards and more by taking an active role in our personal wellbeing by participating in wellness activities like wellness challenges webinar preventive screening and more.

Why work at Presbyterian
As an organization we are committed to improving the health of our communities. From hosting growers markets to partnering with local communities Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients members and the communities we serve. We are locally owned notforprofit healthcare system of nine hospitals a statewide health plan and a growing multispecialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees including more than 1600 providers and nearly 4700 nurses.

Our health plan serves more than 580000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drugfree and tobaccofree employer with smoke free campuses.