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Manager, HEDIS Production

Description

UPMC Health Plan has an exciting opporunity for a Manager, HEDIS Production for the HEDIS Improvement department located in downtown Pittsburgh's US Steel Tower. This position will predominately work remotely but will report to the office as needed. 

The Manager of HEDIS Production will be responsible for implementation of HEDIS initiatives including but not limited to: manage HEDIS projects; track and monitor the HEDIS improvement 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; all aspects of quality control; collaboratively work with quality teams and operational areas for all quality programs as assigned; hire and develop staff and provide directions to staff in report development and production; data analysis and quality intervention; and special ad hoc projects.

Responsibilities:

 

  • Maintain documentation of existing issues, fixes and progress
  • Document and maintain policies and procedures of the team / department
  • HEDIS/CAHPS/HOS improvement; work closely with quality management and operation teams to identify improvement opportunities and develop effective interventions. Meet CMS, the stat and NCQA quality-oriented regulatory requirements based on HEDIS/CAHPS/HOS data
  • Design and manage routine & special projects which may require oversight of other departments' work and coordination of a wide variety of functions
  • Identify division needs and report to management as appropriate
  • Report staff productivity on a weekly, monthly and quarterly basis
  • Contribute to the strategic direction and leadership team of Quality Performance Management including provide consultation and expertise to other departments
  • Performs in accordance with system-wide competencies and behaviors and health plan values, including professional self development
  • Prepare and distribute work assignments while managing a diverse staff of Business Analysts
  • Manage and develop assigned staff; hire talented staff and provide training and development tools for staff professional growth
  • Recommend changes to business and technical processes based on subject matter knowledge
  • Perform peer reviews as requested in addition to routine staff performance reviews
  • Work collaboratively with Provider Network team to develop physician practice performance profiling on HEDIS/HOS metrics, identify opportunities for improvement, and support/manage change implementation
  • Other duties as assigned, including interdepartmental committees and work groups
  • Oversight of staff for report development, including writing code, report production and use of appropriate data sources
  • Manage the HEDIS Production team to develop HEDIS programming and reporting
  • Meet deadlines and turnaround times set by the department director and senior management (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both)

 

Qualifications

  • Bachelor's degree required in computer science, information systems or a related field.
  • Extensive experience (5 years or more) in systems analysis or software engineering.
  • Management experience in managed care setting or other related healthcare organization preferred.
  • Superior computer skills are required, with expert knowledge in relational databases and data migration, programming languages and proven demonstration of the above required (specifically SQL, Oracle)
  • Ability to write code, use multiple data sources and generate reports required.
  • Strong organizational, communication, analytic, change management skills required.
  • Project management and process improvement skills required.
  • Collaboration and strong team player a must.
  • Person must demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis.
  • Knowledge of HEDIS/NCQA standards or other healthcare related quality measurement processes is desired.
  • Excellent verbal and written communication skills.
  • Experience in achieving results without direct control over resources; strong influencing skills and demonstrated ability to develop strong interdepartmental relationships.
  • Ability to instruct and train on new technologies and tools essential.
  • Must be proficient with MS Office (including Excel, Word, and Power Point); experience with using SAS or other statistical applications a plus


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