Job Description

Job Title: Director HEDIS Product & Quality Analytics
Job ID: 726266
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: HEDIS IMPROVEMENT
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC is actively seeking a full time Director, HEDIS Product and Quality Analytics to support UPMC Health Plan! This will be a Monday through Friday daylight role located in downtown Pittsburgh, Pa.

 

We are looking for a proven leader that has worked with HEDIS reporting systems from start to finish.  This individual should have a strong background in health data analytics and understand end to end production on building quality measures.

 

 The Director HEDIS Production and Quality Analytics takes the lead in driving success for key quality measures development and analytic reporting functions that support health plan strategies and the bottom line, including success with HEDIS, CMS Stars, NCQA accreditation and ratings, Pennsylvania State reporting (PAPM), and health plan quality initiatives. Provides strategic direction and leads team production of quality reports related to clinical gaps in care, ancillary services, hospitals, as well as integration with the IDSF for quality reporting, enhancement of electronic data sharing and other strategies. Maintains and creates the UPMC HEDIS data engine which supports all Quality functional activities for the health plan. Ensures tight quality control processes for integrity of data results and provides leadership for implementation and maintenance of progressive automation and data visualization strategies. Directly supports HEDIS and performance metric data submission to CMS, NCQA, and DHS while simultaneously supporting the measure audit/validation process from State and Federal regulatory entities. Provides oversight and leadership over both QI measure production and QI data visualization/analytics to inform product line business decisions.

Responsibilities:

  • Align CMS and NCQA requirements with the quality metrics for provider reporting through threshold changes and new measure data reporting
  • Coordinate with UPMC Enterprise, Health Information Exchange Vendors and others to continually enhance methods to capture data from the electronic medical record and other data sources to be used in HEDIS and quality operations
  • Create a clear strategic data use path for performance measurement and analytics across multiple business units and stakeholders
  • DATA GOVERNANCE Role: Application Steward Applications: ChartNET Application Steward: Governs specific applications and has decision rights and accountability over an application. Responsibilities include but are not limited to, maintaining an application inventory and related metadata, enhancing data collection processes to reduce data integrity issues, prioritizing data integrity issues, enhancing testing and validation of outbound data, participating in the creation and use of master data. For additional information, please consult the Information Ownership and Classification Policy (HS-DG3000) in the system-wide policies section of the UPMC Infonet which outlines the responsibilities and rights of the Information Owners, Information Stewards, and the Data Governance Council for the appropriate use and management of data. http://infonet2.upmc.com/Policies/systemwide/Documents/HSDG3000.pdf
  • Maintain industry-wide perspective on major trends and identifies implications and opportunities for Quality Department operations
  • Manage production of quality reports related to NCQA Quality Compass, monthly HEDIS and Pennsylvania state reporting
  • Manage vendors that supports HEDIS processes and provider data sharing and oversee the acquisition of software, applications, and other information technology tools in order to continually raise the HEDIS related technical sophistication and capabilities
  • Oversee planning, surveillance, and progress for stated short- and long-term goals, and regularly communicate updates and impact to senior executives.
  • Provide strategic direction for new quality reporting capabilities that drives improvement, including enhanced data visualization, automation of routine reports and project specific reports for internal and external health plan use
  • Provides supervision and leadership over the accurate and timely production of data infrastructure, clinical gap in care quality performance reports, analyses, operational reporting, and other analytics to meet the Quality Department HEDIS and other regulatory quality requirements for all lines of business.
  • Sets a clear strategic vision for data visualization, report automation and supplemental data initiatives centered around data completeness and robustness
  • Strategically enhance provider reporting tools and processes that allow providers to receive and manage data on-line, report the number of gaps to next improvement threshold and efficiently electronically share clinical data back to the health plan.
  • Support data reporting for ongoing and newly developed quality initiatives

 

Qualifications

  • Bachelors Degree required, Masters preferred.
  • At least seven years of IT related experience in report generation, database production/maintenance
  • Seven years managed care experience preferred
  • Strong project management and process improvement skills.
  • Multiple years experience in HEDIS and QI measure configuration
  • Knowledge of HEDIS and HEDIS-Like reporting requirements for Commercial, Medicare, Medicaid, Exchange and preference to have knowledge of custom-built State performance metrics
  • Superior computer skills including SAS, SQL, Microsoft Access, Excel and other statistical software packages.
  • Knowledge of data visualization and dashboard analytic tools that support report and query automation (i.e. Tableau, PowerBI, COGNOS, etc.)
  • Excellent analytical and problem solving skills.
  • Strong leadership skills and independent decision making ability.
  • Minimum of two years managerial or supervisory experience required.
  • Excellent presentation, written and verbal communication skills required, as well as strong organizational skills.
  • Knowledge of standard and non-standard HEDIS data sources (supplemental, claims, etc.)

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 to $0

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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EXCELLENCE & INNOVATION

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