This position will require attendance in our office in Coral Gables, FL

Position Purpose:  The HEDIS Manager oversees all aspects of Healthcare Effectiveness Data and Information Set (HEDIS) operations at Doctors HealthCare Plans (DHCP), including strategic planning, data collection, quality control, reporting, and analysis. This role ensures compliance with the National Committee for Quality Assurance (NCQA), regulatory agencies, and supports the health plan’s quality goals and strategic initiatives across all lines of business (Medicare Advantage and other applicable programs). The HEDIS Manager is a key leader in quality measurement, driving performance improvement initiatives that enhance member health outcomes.

Key Responsibilities:

• Manage all aspects of the day-to-day activities supporting annual HEDIS and Medicare STARS submissions, including reporting, monitoring compliance, and ensuring data accuracy for timely annual reporting.

• Ensure the accuracy and completeness of supplemental data sources and manage data exchanges with vendors.

• Oversee post-audit reviews to define operational improvements for future HEDIS cycles.

• Identify, communicate, and act on opportunities for quality improvement based on performance data.

• Serve as a subject matter expert on quality measurement, HEDIS, STARS, CAHPS, HOS, and related quality programs.

• Stay current with industry standards, regulatory updates, and measure specifications.

• Serve as the key contact for external HEDIS vendors and internal resources to ensure timely and accurate reporting of performance metrics to CMS.

• Collaborate across functions and departments to ensure accurate data and reporting, share best practices, and coordinate with Care Management as needed to meet HEDIS measures.

• Drive year-round proactive gap closure by working with vendors and analysts responsible for data abstraction, managing files, claims, and eligibility.

• Analyze and provide Quality-reported data and shared information.

• Research and recognize all relative information for supplemental data extraction, formal chart-chase data capture, and entry of all formal claim information working closely with our vendor to maintain an accurate and updated dashboard/system.

• Communicating with internal departments and providers as required in all aspects of HEDIS and Quality Improvement

• Perform additional duties as assigned to support DHCP’s quality improvement strategy and organizational goals.

  Qualifications:

   

• Bachelor’s degree in business administration, Healthcare management or related field or equivalent experience.

• Minimum 5 years of experience in HEDIS, quality improvement within a Medicare Advantage, DNSP or Medicaid health plan.

• Minimum 4 years of leading staff /supervisory/management experience. 

• Demonstrated leadership skills in working with clinical professionals and office staff.

• Ability to coach and lead others on a collaborative basis to ensure team success.

• Previous Experience with HEDIS quality measurements, health plan STAR ratings, and quality reporting.

• Excellent analytical, organizational, planning, verbal and written communication skills. 

• Ability to manage multiple projects in a fast-paced environment and meet necessary deadlines.

• Proficiency with Microsoft Products, including Office, PowerPoint, Word, and Excel (with Pivot table experience). 

• Ability to perform data mining, reporting, and analysis of data and make recommendations for improvement based on data outcomes.

• Knowledge of project management fundamentals.

• Detail-oriented with strong organizational and time management skills.

• Ability to engage physicians, advanced care providers, vendors, clinical leaders, and other key stakeholders to deliver member-centered care.

• Demonstrate flexibility in response to unexpected changes.

• Bilingual in English and Spanish is required.

  Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.   

  No Third Party Agencies or Submissions Will Be Accepted.   

   

  Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP   

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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