At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

UPMC Life Changing Medicine
Search Our Jobs

   Current UPMC employees must apply in HR Direct

Director, HEDIS Production & Quality Analytics

Description

Purpose:
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, including success with HEDIS, CMS Stars, NCQA accreditation and ratings, Pennsylvania State reporting (PAPM), and health plan quality initiatives. Creates directioning for NCQA E-measures and Digital measures along with acquisition of eclinical data for 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. Provides oversight to development of analytic reports and dashboards to track quality and outcomes for quality improvement initiatives and partners with finance and network analysts to deliver necessary quality measures data for applicable specialty value based payment models that integrates clinical and claims data.

Responsibilities:

  • Support data reporting for ongoing and newly developed quality initiatives
  • Align CMS and NCQA requirements with the quality metrics for provider reporting through threshold changes and new measure data 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
  • Manage production of quality reports related to NCQA Quality Compass, monthly HEDIS and Pennsylvania state reporting
  • Oversee planning, surveillance, and progress for stated short- and long-term goals, and regularly communicate updates and impact to senior executives.
  • 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
  • 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
  • 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.
  • Maintain industry-wide perspective on major trends and identifies implications and opportunities for Quality Department operations
  • 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. 

Qualifications

  • Bachelor's Degree required, Masters preferred.
  • At least 7 years of IT related experience in report generation, database production/maintenance
  • Minimum of five years managerial or supervisory experience required.
  • 7 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.
  • 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/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

Talent Network