Salary Range: $104,280 - $161,634
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status:Exempt
Department:Quality Improvement
Reports To:Manager, Quality Improvement

The HEDIS Project Manager is responsible for managing the Healthcare Effectiveness Data and Information Set (HEDIS) as outlined in the Medi-Cal and Cal Medi-Connect contracts to drive financial metrics around auto assignment and quality withhold measures.

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Lead and facilitate medium to large scale HEDIS and quality projects by providing direction for project framing, organization, business case analysis, implementation, and outcome/success measurement.
2. Ensure the accuracy of HEDIS data and timely completion of the HEDIS project.
3. Create, monitor and execute process improvement project work plans and deliverables, including working with the Manager of Quality Improvement with ongoing HEDIS program management.
4. Serve as an internal and external liaison regarding interdepartmental work and communicate relevant information to vendors and auditors.
5. Develop and maintain all appropriate project documentation, including timelines, project scope, decision logs and work plans. This includes development of process documents including, process maps, workflows, and desktop procedures.
6. Monitor timeliness of projects, cost management, and resource usage to ensure completion and implementation of project and budget variances.
7. Identify, research, and resolve project issues and escalate critical issues, problems, and delays to management and executive leadership, as needed.
8. Lead annual HEDIS audit with external auditors as required by National Committee for Quality Assurance.
9. Conduct studies of operations, workflows, and fact gathering sessions with stakeholders to document, quantify, and specify process improvement efforts. Work with internal stakeholders and business leaders to identify the gap between current and desired results.
10. Utilize HEDIS technical specifications to perform database quality review.
11. Provide oversight of chart retrieval management as well as the vendor and internally retrieved records process.
12. Recommend Performance Improvement Plans (PIPs) for key measures and initiatives.
13. Understand and track applicable regulatory and reporting requirements.
14. Ensure accuracy and regulatory compliance for all materials or documents.
15. Attend off-site meeting or events as necessary.
16. Other related duties as required or assigned.

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor's Degree in Management, Business, Healthcare Administration, or related field; or equivalent experience, training, or coursework. (R)
2. One year of project management experience. (R)
3. Experience in a quality improvement or compliance environment involving managed care or health care reporting. (R)
4. Ability to manage vendors. (R)
5. Understanding medical office operations as it relates to medical records and electronic medical record systems. (R)
6. Basic data analytic skills. (R)
7. Ability to interpret technical specifications published by NCQA for HEDIS and provide guidance to technical resources, such as the IT department. (R)
8. Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff. (R)
9. Self-directed with ability to assume responsibility, work independently, organize, prioritize, and effectively manage competing initiatives in a fast paced, dynamic environment with a high level of ambiguity (R)
10. Ability to direct and manage large-scale, complex, cross-functional, multi-departmental projects to completion with minimum supervision. (R)
11. Ability to think creatively and work strategically, to help drive innovative solutions yielding measurable results to the organization. (R)
12. Ability to gather and analyze data, organize and write reports, and organize work efficiently. (R)
13. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as such as MS Word, Excel, Power Point, and Outlook. (R)
14. Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
15. Excellent communication skills including the ability to express oneself clearly and concisely when interacting with internal and external stakeholders over the telephone, in person or in writing. (R)
16. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
17. Ability to assume responsibility and exercise good judgment when making decisions within scope of the position. (R)
18. Ability to maintain confidentiality. (R)
19. Ability to comply with all SCFHP policies and procedures. (R)
20. Ability to perform the job safely and with respect to others, to property and to individual safety. (R)
21. Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
22. Project Management Certification. (D)

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors in person, by telephone and via work-related electronic communications.

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies; and sit or stand for extended periods of time. (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less. (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment. (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone. (R)
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically throughout a typical workday; attention to detail. (R)

General office conditions. May be exposed to moderate noise levels.

EOE