Senior Quality Manager with HEDIS ==USC / GC ==PST Prefer ==Remote

[US Staffing open position]

Please send resume –-- muk...@rconsultinginc.com

Title       :             Senior Manager Quality

Duration :            6+ Month

Location :             Remote

 

Please submit candidates as usual and have THE CANDIDATE ANSWER the questions below- they can NOT use AI and need to be DETAILED- WHERE/WHEN/HOW, etc. THEY ARE AT THE VERY BOTTOM.

 

**MUST HAVE LEAD HEDIS EXPERIENCE**

 

Job Title
ORGANIZATIONAL INFORMATI
Reports To:	Director Quality
Supervises:	Quality Management RNs, Principal Clinical Informatics Specialist, HEDIS Project Manager, Quality Technical Credentialing

 

Key Relationships:

Reports directly to the Director Quality and works closely with leaders in the Healthcare Experience and Population Health, Data Analytics, Operations, and Clinical Outcomes & Care Design teams. Additional key relationships include Medical Directors and Pharmacists. This role is also responsible for working closely with key network partners on the acquisition of clinical data to integrate within the Providence Health Plan data ecosystem. The position directly supervises professional and program staff, including core leaders within the Quality Management Department.

 

GENERAL SUMMARY
The Senior Manager Quality oversees the HEDIS team and is responsible for leading the development and execution of data acquisition strategies to support Providence's quality programs (CMS MA Stars, NCQA ratings, CMS Quality Rating System, and OHA's Medicaid CCO metrics). This role involves collaborating with Providence cross-functional teams, external partners, and technology vendors to ensure efficient, high-quality, and compliant data collection from diverse sources, including Electronic Health Records, Health Information Exchanges (HIE's), and other data sources. The Senior Manager Quality will also drive innovation in data acquisition methodologies, optimize operational processes, and ensure alignment with organizational goals. Strong leadership, strategic thinking, and expertise in clinical data management and digital quality transformation are essential for success in this role.
•	Leads HEDIS and Supplemental Data Acquisition Strategy  • Responsible for the complete oversight of HEDIS program planning, updates, and vendor oversight.  • Develops and executes strategic plans to optimize acquisition of clinical data from electronic medical records (EMRs), claims, labs, provider portals, Health Information Exchanges (HIE’s), and other relevant data sources for HEDIS and quality measure reporting.  • Ensures strategies align with regulatory requirements, NCQA HEDIS specifications, CMS requirements, and organizational goals.  • Identifies, evaluates, and manages relationships with external data vendors and technology platforms, as applicable.
•	Oversees Supplemental Data Collection Initiatives  • Manages the process for collecting, validating, and integrating supplemental data from providers and health systems to close care gaps and improve measure performance.  • Ensures supplemental data meets regulatory and audit readiness standards for HEDIS reporting.
•	Cross Functional Collaboration  • Partners with Quality Analytics, Business Intelligence, Information Systems, Quality, and other internal stakeholders to streamline data flows and improve data availability for quality metrics.  • Works closely with analytics teams to ensure data usability and integrity for performance improvement
•	Technology Enablement and Innovation  • Evaluates and adopts HIE tools, Natural Language Processing (NLP), and other digital solutions to enhance data acquisition capabilities.  • Leads initiatives to automate and scale data ingestion and abstraction processes.
•	Data Governance and Compliance  • Establishes governance frameworks and metrics to monitor data acquisition quality, completeness, and timeliness.  • Works with the Business Intelligence, Quality Analytics, and Information Systems teams to develop processes to ensure data integrity and feedback loop.
•	Leadership  • Leads and mentors staff, including hiring, training, goal setting, performance evaluations, the development of corrective action plans, monitoring performance improvement opportunities, and termination when necessary  • Identifies training needs and provide for the development and continuing education of professional staff to ensure competency  • Develops and manage budget for expenses and FTEs within the department
•	Quality Improvement  • Responsible for facilitating root cause analyses (i.e., medical record reviews) when performance deficiencies are identified and prioritized by internal stakeholders. Objectives of the root case analyses are to identify barriers and recommend interventions to drive quality improvement  • Oversight of the clinical quality improvement activities, which includes direct engagement with key provider partners on QI strategies, provider feedback, measure education, and best practices  • Tracks and reports on key performance indicators related to HEDIS data completeness, provider engagement and vendor performance, if applicable

 

EDUCATION
Required/Preferred	Education Level	Major/Area of Study	And/Or
Required	Bachelor's Degree	Healthcare, Data Analytics, Business Administration or related fields.
Preferred	Bachelor's Degree	Nursing.

 

EXPERIENCE
Required/Preferred	Minimum Experience	Details
Required	7 years	Experience working with clinical quality measurement and reporting (e.g., HEDIS, eCQM, etc.) in a clinic, hospital, or Health Plan setting.
Required	5 years	Experience in HEDIS administration and supplemental data collection strategies.
Required	5 years	Progressive leadership experience.
Required	5 years	Experience with project management, program evaluation, and team facilitation.
Required	3 years	Knowledge of interoperability standards such as HL7, FHIR,CCD, and API’s for healthcare data exchange.

 

JOB SPECIFIC KNOWLEDGE, SKILLS and ABILITIES
•	In depth understanding of HEDIS measures, NCQA specifications, and CMS quality programs.
•	Strong knowledge of clinical data sources, including EMR’s, claims, lab systems, and HIE’s.
•	Familiarity with supplemental data requirements and standards for audit readiness.
•	Knowledge of interoperability standards such as HL7, FHIR, CCD, and API’s for healthcare data exchange.
•	Advanced knowledge of desktop software applications (e.g., MS Outlook, Word, Excel, etc.).
•	Strategic planning and execution for large scale clinical data acquisition initiatives.
•	Strong project management and organizational skills with the ability to manage multiple concurrent initiatives and deadlines.
•	Excellent communication and stakeholder engagement skills, especially in cross functional and provider facing environments.
•	Leadership and team development skills with the ability to build and  inspire and inspire high performing teams.
•	Ability to identify gaps in data quality access, and completeness and lead efforts to remediate them.
•	Ability to translate clinical and regulatory requirements into actionable data strategies.
•	Ability to drive adoption of digital tools and automation technologies for improved data capture.
•	Ability to assess data readiness for audit submission and guide the organization through compliance activities.
•	Ability to influence across all levels of the organization and build partnerships to improve clinical data flows.
•	Demonstrate problem solving, leadership, conflict management, and team building skills in order to ensure a productive work environment and achievement of goals. Support the organization's quality objective by demonstrating flexibility, being proactive, displaying positive team behavior, and willingness to accept responsibilities in a changing environment.

 

 

SKILLS MATRIX QUESTIONS:

1- HEDIS & Clinical Quality Expertise:
“Can you describe your experience managing HEDIS programs and supplemental data collection initiatives? How have you ensured compliance with NCQA, CMS, or state Medicaid reporting requirements?”

2-Data Acquisition & Interoperability:
“What strategies have you used to acquire clinical data from EMRs, labs, HIEs, or other sources? Can you explain your familiarity with interoperability standards like HL7, FHIR, CCD, or APIs for healthcare data exchange?”

3- Leadership & Team Management:
“Tell me about a time you led a team responsible for clinical quality measurement or data acquisition. How did you mentor staff, manage performance, and ensure team goals were met?”

4-Process Improvement & Technology Enablement:
“Have you implemented digital tools, automation, or data abstraction processes to improve clinical data capture or HEDIS reporting? Can you give examples of results achieved?”

5-Cross-Functional Collaboration & Stakeholder Engagement:
“Describe a project where you worked closely with analytics, operations, or provider teams to improve data quality or completeness. How did you navigate competing priorities and influence stakeholders?”