Under general supervision responsible for developing and implementing department business plans and overseeing department operations with specific responsibilities for the overall management of NCQA accreditation and HEDIS activities consistent with applicable regulations, and HPSJ goals and objectives. Work is varied and moderately complex, and requires a moderate degree of discretion and independent judgment.
- NCQA and HEDIS coordinators at the director’s discretion.
- Develops department objectives and action plans; monitors progress and implements appropriate interventions based on results.
- Plans and assigns work; monitors department workload; makes timely and effective adjustments.
- Develops and oversees completion of detailed NCQA accreditation project plans linked with accreditation standards, required quality studies, prioritized interventions and other requirements; ensures the timely and accurate completion of deliverables.
- Creates and oversees completion of HEDIS data collection and reporting, including HEDIS Roadmaps; ensures the timely and accurate completion of deliverables.
- Develops and implements internal audit activities to ensure compliance with accreditation andn HEDIS standards and requirements; develops and oversees corrective action plans.
- Develops and oversees the successful implementation of data, provider and member interventions, including distribution of provider report cards, and development and implementation of member incentives.
- Compiles, develops and submits or oversees the compilation, development and submission of internal and external reports, including surveys, and those required for HEDIS reporting and NCQA accreditation.
- Develops, implements and maintains, and oversees the development, implementation and maintenance of appropriate and required records, including document libraries for HEDIS and NCQA.
- Develops, implements and maintains department policies and procedures; makes recommendations for revisions; communicates changes to appropriate individuals in a timely and effective manner.
- Maintain all vendor and consultant relationships related to NCQA and HEDIS.
- Develops and delivers multidisciplinary training and education programs for staff, providers, and members regarding HEDIS, CAHPS and NCQA.
- Promotes and maintains, and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
- Hires, supervises and retains competent staff.
Knowledge, Skills, Abilities and Competencies
- Knowledge of the health care industry especially the managed care industry and its products and services.
- In-depth knowledge of Quality Management principles and practices.
- In-depth knowledge of HEDIS measures, reporting and improvement processes, and ability to develop and implement effective programs and improvement activities
- In-depth knowledge of NCQA standards, their application to quality, and ability to develop and implement effective programs and improvement activities.Strong analytical skills, including the ability to identify relevant metrics, draw conclusions and take action based on results.
- In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain
- Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.
- Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
- Decision quality: Makes good and timely decisions that keep the organization moving forward.
- Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.
- Ability to develop and execute goals and associated business plans.
- Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
- Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.
- Ensures accountability: Holds self and others accountable to meet commitments.
- Drives results: Consistently achieves results, even under tough circumstances.
- Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of HPSJ.
- Strong oral and written communication skills, including the ability to communicate professionally and effectively with individuals and groups inside and outside of HPSJ.
- Strong presentation skills, including but not limited to the ability to tailor presentations to specific audience, and identify key messages.
- Collaborates: Builds partnerships and works collaboratively with others to meet shared objectives.
- Persuades: Uses compelling arguments to gain the support and commitment of others.
- Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
- Being Resilient: Rebounds from setbacks and adversity when facing difficult situations.
- Strong knowledge of change management theory, with the ability to implement effectively.
- Strong project management skills and demonstrated ability to lead complex, cross functional initiatives.
- Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
- Strong supervisory and leadership skills, with the ability to supervise staff in a manner that maximizes employee performance and business results.
- Proficient in Microsoft Office suite.
- Ability to handle confidential information with appropriate discretion.
- Quality experience in a health plan and/or with Medi-Cal or Medicaid populations
Education and Experience
- Bachelor’s degree in nursing, business management or other relevant disciplines; and
- At least three years of progressive experience in Quality Improvement, including HEDIS or NCQA activities; and
- At least two years of supervisory experience; or
- Equivalent combination of education and experience.
- Experience in quality in Medi-Cal Managed Care.
- Experience leading HEDIS and NCQA accreditation programs, activities, etc.