HEDIS Quality Program Manager – Ochsner Health Plan – Hybrid

We’ve made a lot of progress since opening the doors in 1942, but one thing has never changed – our commitment to serve, heal, lead, educate, and innovate.  We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. 

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters.  Come make a difference at Ochsner Health and discover your future today! 

This job is responsible for directly implementing and overseeing the HEDIS process, including project management and management of external vendors. This role is responsible for tracking key milestones and adjusting project plans Through record abstraction and data analysis, this role is responsible for identifying deviations in care, utilization opportunities, quality opportunities, and care gaps needed for closure.

Education

Required – Bachelor’s degree in Nursing or other clinical field.

Work Experience

Required – 4 years of healthcare quality experience.

Preferred – HEDIS, Medicare, or Accountable Care Organization experience.

1 year of data management, project management or managed care experience.

Certifications

Required – Current RN License in the state of practice OR other current clinical license.

Knowledge Skills and Abilities (KSAs)

• Ability to perform data mining, reporting, and analysis of data and make recommendations for improvement based on data outcomes.
• Knowledge of project management fundamentals.
• Must be proficient in Excel (pivot table, v-lookup), web-based reporting, quality applications, and electronic medical records.
• Knowledge of quality and process improvement best practices. Ability to demonstrate flexibility in response to unexpected change. Understanding of HEDIS quality measurements, health plan STAR ratings, and operational excellence.
• Ability to engage physicians, advanced care providers, vendors, clinical leaders, and other key stakeholders to deliver member-centered care.

Job Duties

• Develop and maintain a detailed HEDIS project plan to include milestones, tasks, and target or actual dates of completion.
• Manage all aspects of the day-to-day activities supporting annual HEDIS and Medicare STARS submissions. This includes reporting, monitoring compliance and accuracy of the data, and updating the data continuously so the annual report(s) are completed in a timely manner.
• Serve as key contact to external HEDIS vendors and internal resources to ensure vendors communicate Health Plan performance metrics to CMS accurately and timely.
• Collaborate across functions and departments to ensure accurate data and reporting. Share best practices. Coordinate with Care Management as needed to ensure HEDIS measures are met by producing and reviewing reports and audits with other key leaders to improve Health Plan performance.
• Drive year-round proactive gap closure by working with vendors and analysts responsible for research, data abstraction, managing files, claims, and eligibility.
• Review admission, discharge, and transfer files to identify and implement performance improvement opportunities; communicate findings to Medical Affairs team for resolution.
• Perform other related duties as assigned.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns. The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sedentary Work – Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

The incumbent has no occupational risk for exposure to communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Maryland, New York, Washington, and Washington D.C.

Ochsner Health endeavors to make our site accessible to all users.  If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or careers@ochsner.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. We are committed to the principles of equal employment opportunity and providing a workplace that is free from discrimination based on race, color, creed, religion, pregnancy status, pregnancy-related conditions, national origin, ancestry, mental or physical disability, medical condition, age, veteran status, military status, citizenship status, marital status, familial status, sexual orientation, gender, gender identity or expression, genetic information, political affiliation, unemployment status, or any other characteristic protected under applicable federal, state or local law. These protections extend to applicants and all employment related decisions. View the EEO is the Law poster and its supplement, as well as the pay transparency policy for more information. 

Affirmative Action Policy Statement