Manager, HEDIS Operations (Non-Clinical)
Carolina Complete Health
 Charlotte, NC

Position Purpose:

  • Oversee and ensure HEDIS data accuracy and reporting, including investigations, auditing, and improvement opportunitie.
  • 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
  • Provide functional and technical knowledge for HEDIS across all plans
  • 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
  • Monitor project deliverables to ensure adherence to standards including design documents, test plans and operations documentation and facilitate timely submission of deliverables
  • Support the project lifecycle including requirements gathering, creation of project plans and schedules, manage resources and facilitate project execution, deployment and closure

Education/Experience:

Bachelor's degree in Business Administration, or Health Care Administration 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 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.

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