HEDIS Supervisor

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Job Summary

This position is responsible for the supervising and administering the organization’s Healthcare Effectiveness Data and Information Set (HEDIS) program and data obtained from chart reviews for Coordinated Care Organization (CCO) hybrid metrics, risk management, value-based payments, and internal CCO reviews. This position also works closely with department leadership on managing timelines and priorities to accomplish goals, including supervision of unit staff.

Essential Responsibilities

Program Administration

Identify opportunities to improve the program’s effectiveness and efficiency of work processes.
Implement, monitor and evaluate approved program changes.
Lead or participates in project plans including goals and timelines; identify resources and participants needed to meet deliverables.
Set and continually manage and communicate project expectations; identify and resolve issues and conflicts.
Delegate tasks and responsibilities to appropriate personnel.
Work with Director to evaluate and predict workflows/productivity to meet goals.
Provide input and recommendations for the annual budget.
Act as the content specialist in HEDIS measures.
Understand the implications of the Medicare Star Ratings and work to achieve optimal results for identified measures related to HEDIS.
Develop written material for use by unit staff and external customers (including providers).
Provide on-going training to address programmatic, unit staff and provider clinics needs in all areas related to HEDIS Hybrid review, HEDIS gaps of care, CCO metrics and additional chart review requests.
Make recommendations regarding the use of technologies that may enhance organizational performance and serve as a departmental resource for the implementation of any such technology.
Act as a resource for unit staff, clinic staff, Director, and Chief Medical Officer.
Work with identified CareOregon staff and clinic staff to identify opportunities to support and promote improvement opportunities.
Work collaboratively with other CareOregon departments.

Supervision

Supervises team(s) and recommends team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing needs to meet work expectations; recruits and hires, using an equity, diversity, and inclusion lens.
Plans, organizes, schedules, and monitors work; ensures employees have information and resources to meet job expectations.
Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
Trains, supervises, motivates, and coaches employees; provides support toward employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
Ensures team adheres to department and organizational standards, policies, and procedures.
Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

Perform work in alignment with the organization’s mission, vision, and values.
Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
Strive to meet annual business goals in support the organization’s strategic goals.
Adhere to the organization’s policies, procedures, and other relevant compliance needs.
Perform other duties as needed.

Knowledge, Skills and Abilities Required

Knowledge of HEDIS measures and the ability to interpret them
Knowledge of clinical charting systems
Knowledge of Oregon Health Plan (OHP) benefit package including rules and regulations that pertain to health plan operations
Knowledge of the Division of Medical Assistance Programs (DMAP) and the Centers for Medicare and Medicaid Services (CMS) rules and regulations
Knowledge of NCQA standards
Knowledge of Medicare Star rating process and implications to Medicare Advantage plans
Knowledge of principles of managed care
Ability to use critical thinking skills in problem solving
Ability to use motivation, persuasion and encouragement in order to complete project
Ability to manage multiple tasks and timelines and to remain flexible in a dynamic work environment
Ability to work independently and in a team oriented, collaborative environment
Ability to develop and implement processes and procedures
Ability to provide effective leadership and supervision to groups of people and effectively set priorities
Ability to read, write and verbally communicate effectively
Ability to work collaboratively with team, other CareOregon departments, providers and members
Ability to adapt to different communication styles of team members and customers who may come from a broad spectrum of disciplines
Ability to work in an environment with diverse individuals and groups
Ability to present a positive and professional image
Ability to use basic word processing, spreadsheet and database programs and the ability to learn more complex programs

Physical Skills and Abilities Required

Lifting/Carrying up to 10 Pounds

Pushing/Pulling up to 0 Pounds

Pinching/Retrieving Small Objects

Crouching/Crawling

Reaching

Climbing Stairs

Repetitive Finger/Wrist/Elbow/

Shoulder/Neck Movement

1-3 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

Standing

Walking

Sitting

Bending

Seeing

Reading

Hearing

Speaking Clearly

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

More than 6 hours/day

More than 6 hours/day

More than 6 hours/day

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

Minimum 5 years’ experience in health care, specifically in Quality Improvement with experience in HEDIS data collection
Minimum 1 year’ experience in a supervisory or lead position; lead roles should include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks

Working Conditions

Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

☐ Other:

Travel: This position will include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment and/or mobile technology
Hazards: n/a
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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