HEDIS Program Manager

  • Full Time
  • New York, NY
  • Salary: $100000.0

Smith Arnold Partners

Exciting leadership opportunity with one of the tri-states leading Insurance Providers. We are provide benefits including routine doctor visits, specialty care, hospitalization, urgent and emergent care, preventative health care services, and prescription coverage.

As HEDIS Manager your role is responsible for planning, organizing, directing, implementing, and leading HEDIS department assignments. This position operates within broad objectives to ensure optimum utilization of manpower and budget. This role researches, compiles, and analyzes appropriate and relevant clinical quality data to identify opportunities to recommend and drive execution of process efficiencies in assigned business units to achieve targeted levels of improvement in key operational HEDIS performance metrics.

Title: HEDIS Program Manager
Location: New York, NY (currently remote)
Salary- $95,000-$100,000 


Manages Healthcare Effectiveness Data and Information Set (HEDIS) planning, data collection, quality control, analysis, and reporting to meet all requirements of National Committee for Quality Assurance (NCQA) and regulatory. Applying both business knowledge and technical expertise to supports HEDIS strategies, goals, and initiatives at corporate and plan-level.

Essential Functions include but not limited:

Leads staff in all aspects of HEDIS operations required to meet NCQA submission requirements.
Manages HEDIS auditing process including preparation of HEDIS Road Map and all other documents required by auditors.
Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
Develops and manages annual HEDIS project plan and the appropriate protocols of “chase logic.”
Ensures all HEDIS supplemental data sources are gathered and are completed.
Improves HEDIS reporting process
Serves as a team member for activities focused on HEDIS performance improvement.
Analyzes HEDIS results and identifies HEDIS performance improvement opportunities.
Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect

Management Responsibility:

Hires, participates in and/or recommends development measures and disciplinary actions up to and including termination, evaluates performance, and supervises the work of all direct and indirect reports following established organizational policies, procedures, and practices.
Motivates and encourages staff; leads through change and adversity. Makes decisions as needed and builds consensus as appropriate. Communicates and cascades information to employees in a timely manner and actively participates in the success of cross-organizational programs and initiatives.
Sets clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provides coaching to improve performance and holds regular development discussions with direct reports. Recognizes staff for their contributions.

Education/ Experience:

Bachelor’s Degree in HealthCare related degree required
Master’s Degree preferred in Public Health or Business Management
Minimum 5 years of working experience in the health INSURANCE industry.
Minimum 2 years of HEDIS project management and data collection experience required.
Extensive knowledge of Microsoft Office and SQL programming.
Ability to manage multiple, complex projects with strict deadlines.
Excellent verbal and written communication skills.