Manager, HEDIS Operations (Non-Clinical)

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

THIS POSITION IS REMOTE/WORK FROM HOME. APPLICANTS MUST BE FLEXIBLE TO WORK WHATEVER IT TAKES TO MEET BUSINESS NEEDS ESPECIALLY DURING HEDIS SEASON JANUARY - MAY ANNUALLY.

THIS ROLL WILL SUPPORT ALL LINES OF BUSINESS FOR BUCKEYE COMMUNITY HEALTH PLAN. MUST BE ABLE TO TRAVEL QUARTERLY INTO OFFICE, PREFERRABLY COLUMBUS, OHIO OR OTHER LOCAL OFFICE HUB.

Position Purpose: Oversee and ensure HEDIS data accuracy and reporting, including investigations, auditing, and improvement opportunities. Collaborate with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members.

• Oversee activities, resources, methods, and procedures to achieve improvement in HEDIS measures

• Formulate and ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines

• Provide comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to senior management

• Manage all clinical quality metrics and HEDIS processes and results

• Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities

• Oversee all HEDIS projects to include assignment of nurses, adherence to plan timelines, and vendor oversight for timeliness and quality

• Ensure compliance for all quality audits and maintain all data and process controls
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Bachelor's degree in Business Administration, Health Care Administration, Health-Related field, or equivalent experience. 4+ years of HEDIS project management or healthcare management experience. Advanced working knowledge of HEDIS technical specifications. Quality improvement experience preferred. Master’s degree preferred.

 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act