Director, Quality Operations
$16,000–$17,500 year
RemoteIllinois, United States
Job Summary
Develop and implement targeted interventions for HEDIS, Stars performance, and pharmacy measures to drive optimal health outcomes. Act as subject matter expert on HEDIS measures, audits, and submissions, while educating providers on medical record documentation, coding, and NCQA requirements. Lead documentation, evidence gathering, and submission of NCQA Health Plan and SNP submissions, and monitor supplemental HEDIS data abstraction processes. Collaborate with leadership and provider networks to ensure compliance with federal and state regulations, and facilitate quality improvement committee functions. Create and monitor the annual Quality Management Program Evaluation and work plan, reporting progress to the QM Committee.
Required Qualifications
- Bachelor's degree in Healthcare, Clinical Profession, or Public Health
- Three years direct experience leading or performing HEDIS reporting activities or five years management experience, including experience overseeing HEDIS and Stars reporting
- Intermediate level of expertise in Healthcare Effectiveness Data and Information Set (HEDIS)
- Intermediate level of expertise in Medicare Stars ratings including HEDIS, CAHPS, and Pharmacy measures
- Intermediate level of expertise in Data analysis and continuous quality improvement processes
- Demonstrated experience aligning data sources to HEDIS specifications for proper extract requirements
- Experience integrating clinical data with administrative data and developing supplemental data sets
- Strong knowledge of healthcare delivery
- Excellent Communication skills — Listening, speaking, and writing
- Personal management skills — Plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments
- Teamwork —ability to work well with one or more groups
- Interpersonal effectiveness — Relate to co-workers and build relationships with others in the organization
- Strong work values — Dependability, honesty, and a positive attitude
- Required intermediate Microsoft Excel
- Required intermediate Microsoft Word
- Required intermediate Microsoft Outlook
- Required intermediate Microsoft PowerPoint
Desired Qualifications
- Master's degree preferred
- Registered Nurs Licensure
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