Director, Predictive Modeling and Customer Experience Analytics

Job Summary:

The Director, Enterprise HEDIS Operations and Data Integration leads and provides strategic guidance for HEDIS reporting projects for all markets and products with year-round monitoring and annual required reporting, and oversees data integration and expansion strategies (HIE, Provider data and Supplemental data).

Essential Functions:

• Leads HEDIS Operations and HIE Teams – directs activities, hires, trains, coaches, counsels, and evaluates performance of direct reports
• Develop annual HEDIS project plan; lead project progress and timeliness to ensure deadlines are met
• Support market-specific required quality metric reporting where applicable
• Ensure compliance with HEDIS specifications, policies, operating procedures, and goals in compliance with internal and external guidelines
• Directly responsible for leading all HEDIS and clinical data related audits, leading onsite reviews and the collection and preparation of audit documentation
• Submit thorough documentation and response to auditor requested data or process investigations, summarizes findings and presents to senior leadership team
• Provides strategic support to markets as Subject Matter Expert of HEDIS and other performance measure Technical Specifications
• Expand innovation in clinical data collection, identify data anomalies and close data collection gaps to increase performance outcomes. Lead vendor meetings and onboard new vendors to extend CareSource data reach
• Identify and implement opportunities to improve rates or efficiency of data collection - i.e., alternative sources for administrative or supplemental data, lead meetings with market and enterprise leaders to align with quality improvement goals
• Oversee monitoring and outcomes of supplemental and EHR/HIE databases
• Lead HEDIS data processing efforts for all markets and products for HEDIS engine.
• Collaborate with IT partners to execute HEDIS processing and troubleshoot if issues are identified
• Provide oversight and lead meetings in association with IT for incoming data sources and ensure data quality and integrity and troubleshoot if issues are identified.
• Identify and strategize potential data integration opportunities to optimize data intake for Quality measures
• Lead efforts with Vendor management for RFP and business case buildout
• Lead HEDIS operations and data collection strategy to optimize performance measurement
• Manage relationships and lead conversations with external vendors for HIE and HEDIS  
• Perform any other job duties as requested

Education and Experience:

• Bachelor's degree or equivalent years of relevant work experience is required
• Minimum of seven (7) years of experience working in managed care (multiple states/markets and line of businesses experience is required), health care delivery systems, in a public agency serving a related population, or equivalent experience in quality/process/ project management is required
• Minimum of five (5) years of supervisory experience including hiring, training, assigning work and managing the performance of staff or as a lead in a functional area, managing teams on large scale projects is required
• Minimum of five (5) years HEDIS experience required
• Project management experience preferred

Competencies, Knowledge and Skills:

• Exceptional analytical, problem solving and critical thinking skills
• Demonstrated ability in identifying problems, developing solutions and implementing effective courses of action
• Strong communication skills required, including the abilities to effectively communicate succinctly and to a senior level audience verbally and in writing, internally and externally, and at different levels as necessary
• Build ROI analysis, manage department budget, and provide recommendations to senior leadership to improve data management and analytics related to HEDIS
• Demonstrated ability to work effectively and productively with varied levels of personnel, with professionals and business organizations
• Strong service orientation and consulting skills
• Strong leadership development skills to promote upward and lateral mobility for team
• Ability to lead mission-critical, high visibility projects
• Proven ability to juggle multiple complex priorities within a changing environment
• Knowledge of software development, systems and application lifecycles
• Proficiency in MS Office and Project Management tools

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range: