Manager, HEDIS - Denver Health Medical Plan (* Weekly Hybrid Schedule *)
$98,600–$152,800 year
On-site · Denver, Colorado, United States
Job Summary
Manager, HEDIS role overseeing HEDIS/HOS data collection, analysis, and reporting; collaborates with vendors and IT to ensure accurate data submissions; supports MCR Stars, NCQA accreditation, and population health initiatives; supervises RN and Medical Records HEDIS staff; focuses on data project management, post-audit reviews, and quality improvement across NCQA/HEDIS cycles; requires in-person presence three days per week in Denver, CO, with Colorado residency; emphasizes leadership, clinical terminology, and collaboration with providers and stakeholders to drive member-centered quality improvements.
Required Qualifications
- Bachelor's degree in nursing, health informatics, healthcare administration, public health or related field
- 4-6 years project management experience, preferably in HEDIS/HOS within a managed care environment
- 4-6 years experience performing medical record review, inter-rater reliability, and knowledge of NCQA HEDIS Technical Specifications
- 4-6 years experience with HEDIS quality measurements for health plan STAR ratings and related healthcare quality reporting
- Licenses/knowledge in medical terminology, medical record review, NCQA HEDIS specifications and data reporting
- Demonstrated leadership and staff management abilities; ability to coach and lead cross-functional teams
- Ability to engage providers, vendors, and clinicians to support quality initiatives
- Strong data analysis, reporting, and data management skills
- Proficiency with MS Office and healthcare data systems
- Ability to work in a hybrid in-office setting (Denver, CO) 3 days per week
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