Manager Quality HEDIS Stars

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align value-based care, and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

We are looking for a Manage of Quality for HEDIS/Stars. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, NV then you should consider joining our team.

Primary Responsibilities:

To promote our mission of helping people live healthier lives, the Manager of Quality for HEDIS/Stars coordinates critical components of our quality management program in compliance with regulatory requirements and NCQA accreditation standards. The manager works within highly matrixed relationships to implement and maintain the core infrastructure of quality management program.

• Oversees the implementation of plan quality management components within the market for affiliates and employed medical groups
• Proactively manages and responds to rapidly changing CMS requirements and environments
• Collaborates across business segments to attain or maintain the plan’s compliance with CMS, NCQA, PQA standards and contractual requirements as they apply to the quality management program (HEDIS, Part D/Patient Safety, and Patient Experience)
• Develops and maintains positive relationships with health plan partners within the scope of the quality management program
• Commands a comprehensive knowledge of risk arrangements, contracts, member and provider benefit structure
• Ensures the creation and submission of reports to meet health plan contractual requirements
• Monitors HEDIS reporting requirements and annual reporting processes to confirm alignment with regulatory expectations and successful annual submission
• Identifies gaps in patient care to better director provider and patient engagement for CMS Star Rating
• Prepares presentations and data for health plan and affiliate Joint Operating Committees and Provider education sessions
• Develops strategies for quality improvement opportunities, including HEDIS and Part D/Patient Safety gap closure and patient experience
• Maintains and develops strong collaborative relationships with payors, network providers/affiliates, vendors, and internal P3 Health Partner teams to ensure health data is accurate and complete and outcomes are met related to quality
• Leads analytical and technical support for the development and data capture of Quality Measures
• Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care and experience
• Engages Network Providers, vendors, payers, and internal P3HP departments to educate, train, and achieve improved CMS Star Rating
• Tracks and reports KPIs and KAIs to achieve improved CMS Star Rating
• Other job duties as assigned

Required Qualifications:

• Bachelor’s degree in healthcare related field, or comparable experience
• 3 years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Part D/Patient Safety, NCQA, Stars, auditing, reporting, committee management)
• Experience leading Quality teams or similar supervisory experience
• Experience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/Zoom)
• Advanced level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, and PowerPoint
• Proven solid written and oral communication skills with internal and external partners and employees
• Effective project management skills in creating, evaluating, and improving strategies for project execution

Preferred Qualifications:

• Master’s degree in healthcare, or similar area
• Certified Professional in Healthcare Quality
• Experience in bringing together cross-functional teams to complete projects

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)