Wasson Enterprise
National Manager Quality HEDIS Stars
Wasson Enterprise, Oregon, Illinois, United States, 61061
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align value-based care, and engage patients.We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.We are looking for a
National Manager of Quality for HEDIS/Stars . If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, NV then you should consider joining our team.Primary Responsibilities:Oversees the implementation of plan quality management components, executed by the market Provider Engagement teams, for affiliates and employed medical groupsProactively manages and responds to rapidly changing CMS requirements and environmentsCollaborates across business segments to attain or maintain the plan’s compliance with CMS, NCQA, PQA standards and contractual requirements as they apply to the quality management program (HEDIS, Part D/Patient Safety, and Patient Experience)Develops and maintains positive relationships with health plan partners within the scope of the quality management programCommands a comprehensive knowledge of risk arrangements, contracts, member and provider benefit structureEnsures the creation and submission of reports to meet health plan contractual requirementsMonitors HEDIS reporting requirements and annual reporting processes to confirm alignment with regulatory expectations and successful annual submissionIdentifies gaps in patient care to better direct provider and patient engagement for CMS Star RatingPrepares presentations and data, in collaboration with market leaders, for health plan and affiliate Joint Operating Committees and materials to be used for Provider education sessionsDevelops strategies for quality improvement opportunities, including HEDIS and Part D/Patient Safety gap closure and patient experienceMaintains and develops strong collaborative relationships with payors, network providers/affiliates, vendors, and internal P3 Health Partner teams to ensure health data is accurate and complete and outcomes are met related to qualityLeads analytical and technical support for the development and data capture of Quality MeasuresConducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care and experienceEngages Network Providers, vendors, payers, and internal P3HP departments to educate, train, and achieve improved CMS Star RatingTracks and reports KPIs and KAIs to achieve improved CMS Star RatingOther job duties as assignedRequired Qualifications:Bachelor’s degree in healthcare related field, or comparable experience3+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Part D/Patient Safety, NCQA, Stars, auditing, reporting, committee management)Must be able to travel within Nevada, Arizona, Oregon, and California markets as neededExperience leading Quality teams or similar supervisory experienceExperience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/Zoom)Advanced level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, and PowerPointProven solid written and oral communication skills with internal and external partners and employeesEffective project management skills in creating, evaluating, and improving strategies for project executionPreferred Qualifications:Master’s degree in healthcare, or similar areaCertified Professional in Healthcare QualityExperience in bringing together cross-functional teams to complete projectsEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
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National Manager of Quality for HEDIS/Stars . If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, NV then you should consider joining our team.Primary Responsibilities:Oversees the implementation of plan quality management components, executed by the market Provider Engagement teams, for affiliates and employed medical groupsProactively manages and responds to rapidly changing CMS requirements and environmentsCollaborates across business segments to attain or maintain the plan’s compliance with CMS, NCQA, PQA standards and contractual requirements as they apply to the quality management program (HEDIS, Part D/Patient Safety, and Patient Experience)Develops and maintains positive relationships with health plan partners within the scope of the quality management programCommands a comprehensive knowledge of risk arrangements, contracts, member and provider benefit structureEnsures the creation and submission of reports to meet health plan contractual requirementsMonitors HEDIS reporting requirements and annual reporting processes to confirm alignment with regulatory expectations and successful annual submissionIdentifies gaps in patient care to better direct provider and patient engagement for CMS Star RatingPrepares presentations and data, in collaboration with market leaders, for health plan and affiliate Joint Operating Committees and materials to be used for Provider education sessionsDevelops strategies for quality improvement opportunities, including HEDIS and Part D/Patient Safety gap closure and patient experienceMaintains and develops strong collaborative relationships with payors, network providers/affiliates, vendors, and internal P3 Health Partner teams to ensure health data is accurate and complete and outcomes are met related to qualityLeads analytical and technical support for the development and data capture of Quality MeasuresConducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care and experienceEngages Network Providers, vendors, payers, and internal P3HP departments to educate, train, and achieve improved CMS Star RatingTracks and reports KPIs and KAIs to achieve improved CMS Star RatingOther job duties as assignedRequired Qualifications:Bachelor’s degree in healthcare related field, or comparable experience3+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Part D/Patient Safety, NCQA, Stars, auditing, reporting, committee management)Must be able to travel within Nevada, Arizona, Oregon, and California markets as neededExperience leading Quality teams or similar supervisory experienceExperience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/Zoom)Advanced level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, and PowerPointProven solid written and oral communication skills with internal and external partners and employeesEffective project management skills in creating, evaluating, and improving strategies for project executionPreferred Qualifications:Master’s degree in healthcare, or similar areaCertified Professional in Healthcare QualityExperience in bringing together cross-functional teams to complete projectsEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
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