• 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.

• 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.

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.

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

Preferred Work Experience:

• 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.