Job Description

The Manager of Quality - Medicare interfaces and partners with the Health Plan leadership team and cross functional business partners to provide expertise in how to drive quality performance, HEDIS and custom specifications by providing analytical support, impact analysis, program development, and program evaluation for quality projects including opportunity identification, population health management, and reporting to appropriate regulatory bodies and health plan leadership.

 

Oversee all aspects of HEDIS production and quality performance measures including data extraction, processing, medical record review, survey, audit, and report submission to regulators for assigned Health Plans.  Analyze HEDIS data, Medicare STAR rating data, state performance measures and other quality of care data to identify improvement opportunities.  Oversee regulatory and accreditation compliance, in addition to reporting for member and provider intervention programs when gaps in care are identified.

 

Deliver timely contractual quality reporting to provider partners to improve quality ratings and Pay-for-Performance programs.  Assist in the multi-departmental deliverables to regulatory entities such as Model of Care, Chronic Care Improvement Plans, and Quality Improvement Plans.  Identify, in collaboration with Clinical Quality teams, a set of quality care metrics to be produced regularly.  Develop and deliver these metrics on pre-determined schedules.

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

 



Qualifications

Qualifications:

Bachelor's degree or equivalent certification and / or work related experience

Master's degree preferred

Seven (7) or more years in health care quality focused roles

Significant experience in analytic functions, quality assessment, HEDIS measurement, use of claims data, medical record review and clear advancement in responsibilities and outputs is preferred

Knowledge of federal regulatory and accreditation requirements such as Centers for Medicare and Medicaid Services, National Committee for Quality Assurance, and URAC.

 

Position must be located in Arizona

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online