Description

The Program Manager will be responsible for developing, implementing, managing, and evaluating initiatives of HEDIS initiatives including but not limited to: manage HEDIS deliverables; track and monitor the Annual HEDIS Reporting operations to support CMS quality star ratings, NCQA's best plan ranking and the state requirement for Medicaid/CHIP; identify opportunities and potential barriers in HEDIS, CAHPS, and HOS; collaboratively work with Quality teams and operational areas for all population health programs as assigned; oversee and lead gap in care closure programs completion; lead and assist with department development and provide directions to staff in report development and production; data analysis and quality intervention; and special ad hoc projects.

Responsibilities:

• Coordinate related activities for Annual HEDIS and HEDIS initiatives as necessary to ensure that all aspects of each program are successful and that all impacted departments are aware of progress/updates.
• Manage the auditing process for Annual HEDIS, work with internal UPMCHP departments and auditors for a successful submissions
• Lead the CAHPS/QHP Reporting process to Meet CMS and NCQA quality-oriented regulatory requirements based on HEDIS/CAHPS
• Manage and perform business analysis for Quality Analytics department HEDIS data integrations and HEDIS Programs
• Oversight of UPMCHP Gap in Care systems enhancing Quality Scores and collaboration with UPMCHP Partners
• Work with various internal and external customers to provide relevant deliverables. This may include developing and negotiating contracts as needed with UPMCHP legal department.
• Design and develop new project plans for new programs/events as needed, including all policies and procedures, program outlines, contracts as needed with participating facilities, and all marketing materials.
• As relevant, manage, in part or in full, relevant staff to aid in project implementation
• Meet project plan deadlines (these deadlines may require occasional extended daily work hours as necessary).
• Manage various programs, campaigns, and events related to area of program expertise.
• Summarize and interpret program results.
• Identify division needs and report to management as appropriate
• Implement programs for maximum results and member satisfaction.

Qualifications

• Master’s degree in health administration or related health field preferred; or Bachelor’s degree with demonstrated successful experience in clinical program administration and/or other health related discipline.
• A minimum of five to seven years of applicable experience in health care delivery is required.
• Three years in health care insurance preferred.
• Strong leadership and interpersonal skills.
• Management experience preferred.
• Strong computer skills, including proficiency in Microsoft Office, Word and Excel.
• Excellent oral and written communication skills.
• Excellent organizational and analytical skills.
• Financial analytic skills preferred.
• Candidate must demonstrate excellent written and oral communication skills.
• Must be able to interact and negotiate with all facets of the wellness industry.
• Excellent planning, documentation, organizational, analytical and problem solving skills are also required.
• Candidate must demonstrate leadership and project management skills.
• Ability to map re-engineering processes to positively impact productivity in terms of timeliness and accuracy.
• Ability to work with and take direction from Senior Management.
• Desire to continue upward progression within organization.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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