Program Manager I, Quality Data Operations

 Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

·         Strive to apply an equity lens to all our work. 

·         Reduce health disparities. 

·         Become an anti-racist organization. 

·         Create an equitable work environment. 

About the Role

The Program Manager I, Quality Data Operations, supports the Healthcare Effectiveness Data Information Set (HEDIS), Consumer Assessment of Healthcare Providers (CAHPS), Qualified Health Plan (QHP), and Health Outcomes Survey (HOS) programs’ data collection and reporting. This includes annual audits and statutory data submissions for the associated state and federal programs. The role involves contributing to the development and maintenance of project plans, tracking timelines, and facilitating accurate and timely data submissions.

Reports To: Manager, HEDIS/CAHPS/QHP Operations & Performance Measurement

Job Code: PM6001

Department: Quality Analytics

Exemption Status: Non-Exempt

Location: Seattle, Hybrid

Remote Eligible: No

Direct Reports: No

 

To be successful in this role, you:

• Possess a Bachelor’s degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or other relevant academic field, or an equivalent combination of education and/or highly relevant experience.
• Have 0-3 years’ experience in program management, preferably related to HEDIS, Risk Adjustment, or general healthcare (preferred).
• Have a PMP, Agile Professional, or other formal project management certification (preferred).
• Have knowledge of program development, product development, process improvement, and program evaluation is strongly preferred.
• Have knowledge of Community Health Centers (CHC), Federally Qualified Health Centers (FQHC), or other healthcare systems focused on those with low income and/or barriers to equitable healthcare (preferred).
• Have experience with Microsoft Office Suite (Word, Excel, Outlook, and Internet Explorer) and Adobe Acrobat, including comfort with pivot tables at a minimum. Experience with SharePoint, Confluence, JIRA, or Smartsheet is preferred.

 

Essential functions and Roles and Responsibilities:

• Oversee and support HEDIS, Prospective Medical Record Review (PMRR), CAHPS (Medicaid & Medicare), QHP, and HOS program management for annual audits. Collaborate with internal teams, third-party auditors, and vendors to ensure projects meet goals and objectives. Help ensure compliance and quality standards are met and address any issues that arise during audits to ensure successful outcomes.
• Facilitate the creation and implementation of data-driven initiatives to improve HEDIS, PMRR, Medicaid CAHPS (Adult & CCC), Medicare CAHPS, QHP, and HOS. Support the assignment of team responsibilities, collaborating with project stakeholders, and ensuring appropriate internal resources are allocated.
• Contribute to the development and maintenance of detailed project plans including milestones, tasks, and target/actual dates of completion. Support in setting SMART goals, resource allocation, and timely execution. Track team adherence to project timelines and clear barriers to team progress, including team conflict. Escalate risks and propose mitigation strategies to management. 
• Facilitate the end-to-end processes of data submission to regulatory bodies ensuring accurate and complete critical statutory data (HEDIS, CAHPS, QHP & HOS). Collaborate with various departments to ensure all necessary resources and processes are in place for accurate and timely data submissions. Coordinate efforts with internal teams and external partners to meet regulatory requirements.
• Identify and address data issues related to improving data generation and flow throughout the organization, including reporting processes and protocols. Ensure data accuracy and completeness by cross-referencing medical records and other data sources including working with vendors to gather proof of record and conducting internal audits (Primary Source Validation). Partner with stakeholders to standardize data formats and ensure consistency for reporting.
• Discover