This position ensures the Clinical Integration program is strategically aligned to national standards and best practices. The Healthcare Effectiveness Data and Information Set (HEDIS) & Performance Metrics will be highly visible inside and outside the organization and will have responsibility to work with physicians to translate best practice into actionable measures. This person will be an internal expert on the HEDIS measurements methodology whose knowledge will be leveraged by several departments. When HEDIS measurements are not available the manager will recommend other best practices from leading experts to fill any gaps measurement. The position requires close attention to detail, extensive experience with health care data, a background in quality measurement, and the ability to clearly and succinctly communicate program changes.

MAJOR RESPONSIBILTIES

Manage, organize, and support the processes for administering CI program measures adhering to the written CI program’s operational specifications detailed for each measure. Prepares project plans, schedules, and resources. Plans work for other stakeholders, directs and monitors the work of staff members, clients, and vendors to meet project goals.Communicates the components of the CI program to APP associates and APP physicians to support understanding of each measure, the impact program changes have on various stakeholders, and when and how performance will be measured. Communications are concise and designed appropriately for the target audience; communications are timed to support the ability of the physician audience to adequately and fairly achieve established performance goals.Work with NCQA, Cerner, and other external vendors to provide primary care and specialty specific measurements that align to the overall population health strategy for the organization.Provide ongoing support of the incentive reporting tools and year end physician incentive calculations.Oversee administration of the CI program’s annual physician reconsideration/appeal process as directed by department leadership.Partner with the quality team and other internal stakeholders to align the CI program with the Population Heath Index and other key reporting indicators for the system.Facilitates and executes on special projects identified by department leadership. Identifies project scope, facilitates ongoing communication between stakeholders, and identifies project objectives to meet short- and long-term goals.

MINIMUM EDUCATION AND EXPERIENCE REQUIRED

License/Registration/Certification Required:  None

Education Required:  Bachelor’s degree in healthcare or related field

Experience Required:  7 years in managed care or hospital network

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

Demonstrates excellent problem-solving skillsDemonstrates excellent written & verbal communicationDemonstrates excellent organization and planningDemonstrated interpersonal skills.Ability to work under tight time constraints.Ability to manage multiple project tasks concurrently.Strong with Microsoft office suite (Excel, Word, Outlook, PowerPoint etc.)Knowledgeable on healthcare quality reporting.Knowledgeable on HEDIS quality measures.Knowledge of healthcare operational reporting acute and non-acuteSome knowledge of project planningSome knowledge of process improvement

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.