Manager, Quality Data

Job Summary

The Manager of Quality Data is an important role on the quality data team. This position will work closely with technical, clinical, and compliance personnel to ensure accurate and timely delivery of Healthcare Effectiveness Data and Information Set (HEDIS) and Survey data to regulatory entities, partners and other stakeholders. This position plays a key role in optimizing data procurement and streamlining operational processes for Extract, Transform, and Load (ETL).

Duties

• Manages the HEDIS and Survey Projects: Updates internal policies and procedures that pertain to functions related to data process, data collection, and Health Insurance Portability and Accountability Act (HIPAA) compliance. Present to groups as needed.
• Staff support and administration: Works with staff to set up incentive goals, and work metrics; Monitors activity to assure staff are engaged; Works with the technical staff to develop databases for data capture and reporting; Conducts verbal or written counseling, writes performance improvement plans, and resolves issues impacting productivity.
• Works with and presents to Plan Partners and provider groups to optimize data quality and completeness.
• Works with the technical staff to produce and assure the delivery of reports for submissions required by NCQA, Centers for Medicare and Medicaid Services (CMS), Managed Risk Medical Insurance Board (MRMIB), and other regulatory or accreditation agencies.
• Resolves issues impacting delays in timelines, staffing, and/or production.
• Initiates and participates in performance/quality improvement initiatives and workgroups.
• Sets work standards and monitors production as indicated by the project plan. Supervise staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
• Oversight of data vendor services.
• Perform other duties as assigned.

Education Required

At least 6 years of clinical outcomes review and quality data experience with strong skills in data validation.

Education Preferred

At least 4 years of leading staff or supervisory/management experience.

Experience

• At least 3 years of experience with HEDIS and Surveys for example, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS), Consumer Assessment of Healthcare Providers and Systems Medicare Advantage and Prescription Drug Plan (CAHPS- MAPD), Qualified Health Plan Enrollee Experience Survey (QHP-EES), Health Outcome Survey (HOS), etc.

Skills

• Communication skills with technical staff in a NCQA accredited health plan.
• Advanced programming skills working with data types such as membership, provider, claims and encounters.
• Working knowledge of MS Access, Excel, and Word software.
• Able to manage project timelines, requested deliverables and developing and maintaining prioritization thereof.

Licenses/Certifications Required

N/A

Licenses/Certifications Preferred

N/A

Required Training

N/A

Physical Requirements

N/A

Additional Information

L.A. Care offers a wide range of benefits including:

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retail Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

Nearest Major Market: Los Angeles