Director HEDIS & Provider Quality Incentives Jefferson Health Plan

Job Details

Job Description

• Able to work in a constant state of alertness and safe manner
• Direct the entire HEDIS and Pennsylvania EQRO process.
• Oversee the planning forecasting reporting and payment for (QCP) and (MQCP) Programs.
• Support the needs of the PCMH program.
• Supervise and manage analyses for senior management and other departments to assure accuracy and integrity of work performed and relevance to the business needs identified.
• Motivate analysts to meet and exceed service requirements and functional objectives.
• Coach and lead HEDIS team to continuously improve performance and value.
• Serve as HPPs liaison with third party vendors such as Inovalon to analyze HEDIS data in order to improve quality.
• Work with other department leaders to define and implement their reporting needs with regard to HEDIS and serve as a broker of available information.
• Assure that HEDIS staff meet the requirements of their reporting departments and that practices are in compliance with company standards.
• Coordinate assign and respond to data requests from other departments. Maintain and foster a collaborative relationship with these departments.
• Participate in companywide initiatives such as new system implementations quality and process improvement. Ensure that data and reporting needs are considered in plan-wide initiatives.
• Create accurate and meaningful utilization and outcome analysis trend and other reports for departmental and management HEDIS related decision-making using Hyperion MS Access MS Excel and other reporting tools as necessary.
• Help determine optimal analysis and presentation of medical data to improve service quality. Direct use of dashboards presentations and spreadsheet reports accordingly.
• Work with IS to ensure that optimal business and reporting tools are available for HEDIS STARS and other company users. Monitor data initiatives with IS Operations and other departments to ensure accuracy and consistency and to avoid duplication of effort.
• Understand and communicate to HEDIS staff how changing business practices will affect data and reporting and implement the necessary changes efficiently and accurately.
• Attend and participate in quarterly Quality Review Meetings (QQRM) for DHS and CHIP. Provide insight into quality trends and report to the state.
• Other responsibilities as assigned.

Minimum Qualifications

• Bachelors Degree in actuarial science mathematics statistics or other analytical field of study.
• 5 years of data reporting and analysis experience with at least 3 years of clinical/healthcare data experience in managed care and/or medical quality assurance setting or other relevant experience. and
• 2 years Experience with Medicaid and Medicare insurance and populations. Experience with provider coding practices using CPT ICD-10 codes and DRGs. and
• 1 year Understanding of delivery and reimbursement of medical services in a managed care environment. Familiarity with the role disease management utilization management and care management play in a managed care organization. and
• Less than 1 year HEDIS program management required.
• Proven leadership or mentoring skills with a data analysis team.
• Strong problem-solving quantitative and analytical skills.
• Ability to use business intelligence query tools computer spreadsheet (Excel) and databases at advanced level.
• Ability to manage technical staff.
• Proven skills with data presentation including charts graphs and other exhibits.
• Ability to communicate effectively both orally and in writing.
• Ability to negotiate workable solutions to customer needs.
• Ability to learn quickly and implement knowledge of new technical processes with assistance of business unit experts.
• Ability to handle multiple responsibilities and changing priorities.
• Excellent organizational skills.

Preferred Qualifications

• Masters Degree in actuarial science mathematics statistics or other analytical field of study.
• 3 years of management experience.

Work Shift

Worker Sub Type

Employee Entity

Primary Location Address

Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.

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