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Health Quality and Stars (HQS) is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners through quality solutions. HQS is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS).

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations.

Location: Remote or if near Louisville hybrid

The Lead for HEDIS Controlling Blood Pressure is responsible for the advancement of the initiative improvement strategy, operational execution and performance oversight in effort to achieve high HEDIS condition management Stars performance targets.  This individual will define improvement objectives focused on clinical gap closure, health outcomes and improved member experience. 

Key Responsibilities

Apply in-depth and broad knowledge of HEDIS condition management measures to develop strategy and implement comprehensive solutions to drive overall Stars performance:

• Accountability for performance and operational excellence of comprehensive programs to improve Star ratings

• Partner with multiple analytics teams to develop, prioritize, deliver, and measure solutions

• Proactively engage the right stakeholders to anticipate headwinds and identify gaps, looking ahead to anticipate pivots and action needed

Provide insights and identify new opportunities for improvement through data analysis of variable factors to determine course of action:

• Ability to make recommendations based on reporting and monitoring by contract, region, provider and aggregate performance, identifying where things are going well and why, as well as where things need to improve and how

• Cross-collaboration with performance management team to interpret and deliver key recommendations to achieve Stars goals

Conduct audits of all data collection and processes to ensure operational excellence across initiatives:

• Create standard operating procedures, document data collection, and establish processes for audit and quality control

• Identify gaps and new opportunities to improve performance

Support key functions with strategic and analytical thinking:

• Requires a general understanding of Stars operations and ability to effectively communicate the Stars story

• Knowledge of the technical specifications and codes within attributed value sets

• Detail oriented and willing to learn the more minute parts of HEDIS measures and gap closure processes with limited guidance and direction

• Use problem solving skills to resolve issues and make decisions in a fast pace, complex, ever-changing environment

• Understand campaign development to provide insights for new concepts, technologies or processes

• Experience with market needs to provide insights to improve performance in key contracts and regions

• Understanding of or experience with clinical setting to advance provider first strategies, influence member interventions and identify new opportunities to impact

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree in Business Administration, Health Administration or a related field

• 7 years of previous innovation, program delivery and/ or strategy experience

• Proven skills in analyzing data trends and identifying performance improvement opportunities

• HEDIS experience

• Strong attention to detail and focus on customer experience

• Effective communication skills, written and verbal

• Effective facilitator – direct collaborative efforts amongst business, analytics and technology partners

• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint, as well as ability to navigate business intelligence tools to review data insights

Preferred Qualifications

• Master’s Degree

• HEDIS Controlling Blood Pressure measure experience