LOCATION: Remote – this is a home based, virtual position that operates Monday – Friday from 8:30am-5:00pm (EST). Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

GENERAL STATEMENT OF JOB

This position is responsible for the end-to-end execution of the annual Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) cycle. This role ensures Vaya meets contractual requirements and regulatory standards set by the National Committee for Quality Assurance (NCQA). This role is responsible for ensuring the accuracy of data collection, timely reporting, and ongoing improvement of quality performance measures. Additionally, the HEDIS manager serves as the HEDIS subject matter expert, leads cross-functional teams, and collaborates with internal and external stakeholders to advance initiatives that improve member outcomes.

Success in this role requires advanced leadership capabilities, strong analytical and communication skills, robust project management expertise, and a deep understanding of HEDIS, NCQA and Medicaid quality standards.

ESSENTIAL JOB FUNCTIONS

HEDIS Oversight:

Lead the planning, implementation, and management of the HEDIS/CAHPS project lifecycle, including oversight of medical record retrieval and any needed chart abstraction. This includes the oversight of accurate and comprehensive medical record reviews, accurate reporting of findings, and maintenance of necessary documentation.
Develop and manage detailed project plans, timelines, and workflows.
Maintain and track compliance with NCQA reporting timelines and submission protocols.
Maintain up-to-date knowledge of annual HEDIS measure revisions and all relevant regulatory changes.
Oversight of staff and abstractors, providing training on updated NCQA technical specifications, as needed, for medical record review process.
Collaborate with the Performance Reporting Team regarding the data submission processes, including coordination with IT for data integration, data gaps, and accuracy of HEDIS and CAHPS submissions.
Partner with internal stakeholders to manage vendor relationships.
Coordinate with Compliance on HEDIS compliance audits.
Coordinate with Quality Strategy and other applicable stakeholders regarding performance trends to identify care gaps and develop performance improvement initiatives to improve scores.
Educate provider networks on documentation standards to ensure medical records accurately reflect the care provided. Partner with Provider Network to facilitate quality incentive and pay for performance programs.
Effectively lead cross functional meetings related to assigned projects and quality initiatives
Demonstrate thought leadership, critical thinking, excellent project management skills, knowledge and experience with program evaluation, and consulting skills.
Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan.
Manage and reports on all clinical and non-clinical program reports and metrics on a standard frequency, in coordination with Performance Reporting Team.
Proactively escalate to leaders when metrics are anticipated to be unmet and/or outliers are identified.
Influence and coordinate the work of cross departmental leaders and staff to achieve objectives, promote accountability to shared workflows, and enhance collaboration without direct supervisor authority.
Prepare summaries, presentations, and updates for leadership teams translating complex program information into clear, understandable content.

Technical Assistance and Education:

At the request of operations and administrative teams, this position may participate in or provide guidance or expertise, when needed, in interdisciplinary care teams or department meetings.
Oversight of staff and abstractors, providing training on updated NCQA technical specifications, as needed, for medical record review process.
Educate provider networks on documentation standards to ensure medical records accurately reflect the care provided. Provide clear and concise communication with both technical and non-technical stakeholders.

Other duties as assigned.

Note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

KNOWLEDGE, SKILLS, & ABILITIES

Deep understanding of coding and proficiency in HEDIS and CAHPS.
Experience in data collection and interpreting complex data.
Ability to develop practical, thorough, and creative solutions to complex problems.
Highly adept computer skills: demonstrated mastery of all MS Office products (including Outlook, Excel, PowerPoint, Word).
Proficient in using HEDIS software, data analysis tools, Microsoft office suite and other relevant technology.
Ability to manage large time sensitive initiatives.
Demonstrated leadership ability with experience managing large scale divisional and organizational change.
Excellent interpersonal skills demonstrated commitment to organizational health and positive workplace culture, and familiarity with concepts for building effective teams.
Strong team player who welcomes collaboration, searches for compromise, remains respectful, maintains a positive attitude, and demonstrates the ability to work harmoniously and collaboratively with individuals at all levels and with varying backgrounds both within and outside of Vaya.
Solution-focused and committed to self-accountability.
Effective communicator who respects others’ ideas and practices active listening.
Excellent oral and written communication skills, including thorough knowledge and excellent skills in English grammar, punctuation, and spelling, and ability to clearly communicate complex ideas and concepts.
Excellent time management skills, including the ability to manage competing priorities and to complete tasks in a timely and accurate manner.
Ability to use critical thinking skills, work independently with little or no direction, demonstrate initiative, and function as a self-starter.

EDUCATION & EXPERIENCE REQUIREMENTS

Bachelor’s degree in Healthcare related field, including but not limited to Public Health, Nursing and Business Administration. Must have:

Minimum of five years of experience with comprehensive implementation and ongoing management of HEDIS data and analytics is required.
Knowledge of HEDIS, CAHPS, coding, and Medical Terminology
Solid facilitation skills with demonstrated excellence in driving multi-disciplinary and cross-functional teams to consensus

Preferred Work Experience:

Health plan experience with day-to-day operations
Clinical experience
Experience leading and managing complex projects/project management

Preferred Licensure/Certification:

Licensure: Full, active, unencumbered North Carolina clinical license in a field relevant to behavioral health (e.g., LCSW, LCMHC, LMFT, RN), with an emphasized preference for any incumbent with a degree in nursing to be licensed as an RN

Certifications: Certified Professional in Healthcare Quality (CPHQ) or ability to obtain CPHQ certification

PHYSICAL REQUIREMENTS

Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers.
Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this position must reside in NC, SC, GA, TN, VA, MD, or FL.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.

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