Director, HEDIS

at  REGAL MEDICAL GROUP INC

POSITION SUMMARY:

The Director, HEDIS will provide direction and supervision to the HEDIS team and the management team of the HEDIS team. The Director will be responsible for developing and implementation of quality measure initiatives. The goal of such initiatives is to drive superior quality measure performance scores for all lines of business (Senior MA, Commercial, Exchange, and Medi-Cal). The Director will serve as an expert resource for quality measure specifications and will provide educational updates to Providers and clinical team members. The Director will assist the team in monitoring production, identifying inefficiencies, updating workflows and managing the team. The overarching function of the Director is to oversee team member outreach efforts, provide ongoing data evaluation and progress reports to the Medical Director and to resolve any discrepancies that have been identified.

EDUCATION AND / OR EXPERIENCE:

• Bachelor degree required.
• A minimum of 5 years’ experience in a healthcare or managed care setting required.
• A minimum of 3 years’ experience dedicated to HEDIS and quality measure performance strategy and/or systems analysis required.
• Must know or have the ability to understand multiple software programs including, but not limited to MS Office (Word, Excel), Business Solutions, DAI Scheduling, Ascender, EZCAP, NextGen.
• Excellent written and oral communication skills.
• Detail oriented. Must be able to meet deadlines and be flexible to demands of the position.
• Ability to work independently.
  Compensation: $120,000 - $140,000 annually

• Provide Continuous monitoring of quality measure date (numerators and Denominators), identify data irregularities, monitor the HEDIS team and their projects.
• Evaluates quality measure data information and assists in establishing priorities for outreach efforts so that goals are achieved.
• Directs and supervises RMG internal outreach team in implementation of patient directed outreach efforts.
• Supervises data reporting and projects being completed by the team.
• Assists in the development of provider and care team directed education regarding quality measure specification details, changes and updates.
• Supports the development and implementation of new programs that may be innovative in their approach to maximize success with member outreach, closure of quality measure gaps and member satisfaction scores (HOS, CAHPS).
• Directs and supervises outreaches and activities regarding quality measures.
• Ensures accuracy and compliance with all CMS guidelines regarding quality measure sets.
• Assists in completing medical record audits and/or retrieving medical chart reviews requested by Health Plans.
• Collaborates with other departments for efficient and effective processing of HEDIS material for issues and outcomes.
• Coordinates care with appropriate functional areas (QI, SNP, TCM, and Pharm) for quality measure sets compliance.
• Attends all meetings applicable to this position inside and outside of the organization.
• Assists in managing (this includes interviewing/hiring/training/monitoring) and supporting the managers for a team of approximately 50 employees.
• Communicate to patients, customers and co-workers know what they can expect from you and follow through
• Be an active listener (make eye contact, validate)
• Assume a neutral position and suspend judgment of others
• Be accountable for your work
• Summarize key information and provide written materials whenever possible
• Validate to ensure understanding
• Anticipate needs that will arise
• All other duties as directed by management
  The pay range for this position at commencement of employment is expected to be between $120,000 - $140,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
  The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
  Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
  If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
  As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.