We are recruiting for a mission-driven Manager, HEDIS - Denver Health Medical Plan (* Weekly Hybrid Schedule *) to join our team!
We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.
Our Values
Respect | Belonging | Accountability | Transparency
Department
Managed Care Administration
Job Summary
Under minimal supervision, the HEDIS manager will oversee the Health Employer Data Information Set (HEDIS), and HOS survey project timelines; collaborates with vendors and internal IT department to ensure all data requirements and submissions are accurate and timely. Supports Population Health and QI teams with metric data and strategy for MCR Stars, Medicaid MLR and NCQA certification. Promotes positive interpersonal (customer) relationships with fellow employees, physicians, patients and visitors. Supervises RN, Medical Records HEDIS personnel.
Essential Functions:
• Data Project Management: Oversees the HEDIS/ HOS data collection, development and analysis; maintains and updates appropriate data collection systems and enters information, as required, using MS Office, and Managed Care systems used to extract data for HEDIS/ HOS while driving and providing oversight of post-audit reviews to define operational improvements for future HEDIS cycles. Ensures compliance with all NCQA HEDIS Audit requirements. (15%)
• Support strategic goals of MCR Stars by providing subject matter expertise on quality metrics and HEDIS strategy (15%)
• Support NCQA accreditation process by providing subject matter expertise on quality standards (10%)
Work with providers on appropriate coding and documentation for HEDIS Stars and MLR measures. Oversee post-audit reviews to define operational improvements for future HEDIS cycles. (10%)
• Process and Procedure: Determines work procedures and expedites workflow; assigns duties and reviews work; prepares necessary and required reports to management. Delegates responsibility/authority. Identifies problems and opportunities for improvement; identifies appropriate solution and involves others in the implementation process. Makes recommendations for cost efficiency and process improvement. Meets all NCQA HEDIS Medical Record Review (MRR) requirements and deadlines. (10%)
• Reporting and Analysis Prepares and/or reviews daily, weekly, monthly and quarterly quality assessment reports and conducts/reports findings for QI data for all lines of business as required for HEDIS/ HOS activities, lead discussions about data/results, provides timely updates. Meets NCQA Compliance Audit activities to include annual training/testing of HEDIS staff and timely completion of Supplemental Data Audit (SD), Medical Record Review Validation (MRRV, Inter-Rater Reliability (IRR) tracking, and supports HEDIS annual roadmap submission. (10%)
• Vendor Management: Partners with vendors and manages tracking progress during and prior to submission such as HEDIS auditor and Hedis Data vendor for medical record capture (10%)
• Staff Management: Creates annual HEDIS training and testing materials per NCQA Technical Specification and compliance audit requirements. Identifies training and staff development needs of employees, recognizes positive behavior and contributions to the staff, using praise, appreciation and rewards, participates in the selection of QI staff, sets performance expectations by developing job specific customer service expectations and behaviors. Promotes guidance/oversight of certain tasks and delegates appropriately. (10%)
• Oversee post-audit reviews to define operational improvements for future HEDIS cycles. (10%)
Education:
Work Experience:
4-6 years Project Management experience, preferably in HEDIS/HOS within a managed care environment required and
4-6 years previous experience in performing medical record review, inter rater reliability and working knowledge of medical terminology and NCQA HEDIS Technical Specifications required and
4-6 years previous experience with HEDIS quality measurements for health plan STAR ratings and
4-6 years previous experience in healthcare, quality improvement, statistics and/or evaluation.
Licenses:
Knowledge, Skills and Abilities:
Prerequisite skills including collecting, compiling and interpreting HEDIS CAHPS , and HOS data for QI studies
Extensive knowledge of MCR Stars program and NCQA accreditation process including previous experience with HEDIS quality measurements, health plan STAR ratings and quality reporting
Knowledge/familiarity with medical terminology, medical record review, NCQA HEDIS Technical specifications, and decision making skills regarding appropriateness of care review.
Provide HEDIS /HOS data for research design planning and analysis to generate quality improvement reports.
Applies efficient research and data collection skills and organize information by line of business succinctly
Ability to work independently as well as collaboratively with other internal and external team members to ensure timelines are met
Utilizes software applications and information systems to perform work processes with responsibility for training on such and providing updates as necessary
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
Ability to engage physicians, advance care providers, vendors, clinical leaders, and other key stakeholders to deliver member-centered care.
Demonstrate flexibility in response to unexpected changes.
Shift
Days (United States of America)
Work Type
Regular
Salary
$98,600.00 - $152,800.00 / yr
Benefits
At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.
Here is a small list of our benefit programs:
Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
About Denver Health
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.
As Colorado’s primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.