Share this Job

Manager, Quality Informatics

Date: Jun 4, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5178 

 

Position Summary/Position

 

Under the direction of the Director of Quality Informatics, the Manager of Quality Informatics is responsible for managing Healthcare Effectiveness Data and Information Set (HEDIS) planning, data collection, quality control, analysis, and reporting to meet all requirements of National Committee for Quality Assurance (NCQA) and other regulatory agencies (DHCS, DMHC, CMS). The Manager of Quality Informatics applies both business knowledge and technical expertise to support HEDIS strategies, goals, and initiatives. The Manager of Quality Informatics is responsible for generating and validating IEHP’s HEDIS rates and serving as the technical lead on all HEDIS audit and submission processes. The Manager of Quality Informatics supervises the HEDIS Reporting and Quality Performance staff in data collection, data validation, monitoring and reporting for all aspects of HEDIS and Quality Performance reporting and improvement activities. The Manager of Quality Informatics provides technical and analytical support to the Performance Measurement Improvement team, in all design, data collection, reporting and monitoring activities for HEDIS improvement initiatives.

Major Functions (Duties and Responsibilities)

 

1. Manages HEDIS Reporting and Quality Performance staff ensuring timely and effective data collection, validation and reporting activities are met.
2. Hires, participates in and/or recommends development measures and disciplinary actions up to and including termination, evaluates performance, and manages the work of all direct and indirect reports following established IEHP policies, procedures, and practices.
3. Motivates and encourages HEDIS Reporting and Quality Performance staff; leads through change and adversity. Makes decisions as needed and builds consensus as appropriate. Communicates and cascades information to Team Members in a timely manner and actively participates in the success of cross-organizational programs and initiatives.
4. Sets clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provides coaching to improve performance and holds regular development discussions with direct reports. Recognizes staff for their contributions.
5. Works with the Director of Quality Informatics on improving possible error identification and on the development of cost-benefit analysis tools for HEDIS improvement programs. 
6. Ensures the HEDIS Reporting and Quality Performance teams maintain up-to-date documentation of all reporting projects and database objects within a project consistently, following departmental standards.
7. Must be proficient in SQL programming to manage a team of SQL programmers.
8. Must be proficient in using Inovalon QSI-XL certified HEDIS reporting tool.
9. Leads staff in all aspects of HEDIS operations required to meet NCQA submission requirements.
10. Manages HEDIS/CAHPS auditing process including preparation of HEDIS Road Map and all other documents required by auditors.
11. Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
12. Develops and manages annual HEDIS project plan and the appropriate protocols of “chase logic.”
13. Ensures all HEDIS supplemental data sources are gathered and are completed.
14. Improves HEDIS reporting process by leading a “lessons learned” process for internal operational improvement.
15. Serves as a Team Member for activities focused on HEDIS performance improvement.
16. Analyzes HEDIS results and identifies HEDIS performance improvement opportunities.
17. Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
18. Other duties as assigned with or without accommodation.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

At least five (5) years of Management experience. At least five (5) years of experience in all aspects of HEDIS reporting processes within a Managed Care Organization with a focus in data design, analysis and reporting required. At least five (5) years of experience in the development of relational databases, complex query design and working with large datasets. At least five (5) years of experience presenting results of data analyses to a variety of audiences.

Preferred Experience

Education Qualifications

 

Bachelor’s degree in Healthcare related field from an accredited institution required.

Preferred Education

 

Master’s Degree in Public Health from an accredited institution preferred.

Professional Certification

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Working knowledge of ICD-10/CPT/HCPCS/NDC coding, medical terminology and knowledge of managed care, claims payment processes and insurance terminology required.

Skills Requirement

 

Strong data analysis, data presentation, spread sheet and database capabilities. Extensive knowledge of data manipulation tools including, but not limited to Microsoft Access, SAS, SSRS and Excel are essential. Strong verbal and written communication skills. Must demonstrate strong critical thinking skills.

Abilities Requirement

 

Ability to clearly present data issues, communicate the approach taken to analyze the issue, and clearly express the results to a wide variety of audiences. Ability to handle multiple projects. Strong attention to detail required. Ability to work well with others across various levels and areas within the organization.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. 

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Use of computer mouse - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Indoors - FREQUENTLY
Lighting - CONSTANTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY
Hearing: One-on-One - FREQUENTLY

 

Starting Salary: $119,100.80  - $151,860.80  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles