Program Manager II, 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 II, Quality Data Operations is responsible for overseeing 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, reporting and analytics. This includes annual audits and statutory data submissions for the associated state and federal programs. The role involves developing and maintaining project plans, tracking timelines, facilitating accurate and timely data submissions, and clearing barriers to team progress. The Program Manager II is also responsible for identifying and triaging data issues, identifying and driving data quality measurement opportunities, and maintaining effective communication with internal and external stakeholders, including managing contracted vendor performance, and evaluating new vendor opportunities. The Program Manager II collaborates with various departments to enhance operational readiness and performance measurement, while also providing status reporting and communications to various levels of leadership.

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

Job Code: PM6002

Department: Quality Analytics

Exemption Status: Exempt

Location: Seattle, Main Office

Remote Eligible: Hybrid

Direct Reports: N/A

 

To be successful in this role, you:

• 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.
• 3+ years’ experience in program management, preferably related to HEDIS, Risk Adjustment, or general healthcare (preferred).
• PMP, Agile Professional, or other formal project management certification (preferred).
• Experience in program development, product development, process improvement, and evaluation is strongly preferred.
• Have experience with 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:

• Serve as a subject matter expert for HEDIS, Prospective Medical Record Review (PMRR), CAHPS (Medicaid & Medicare), QHP, and HOS program management for annual audits. Work directly with internal teams, third-party auditors, and vendors to ensure projects meet goals and objectives. Provide expert guidance on compliance and quality standards and address any issues that arise during audits to ensure successful outcomes.
• Develop, implement, lead, and manage projects and data-driven initiatives to improve HEDIS, PMRR, Medicaid CAHPS (Adult & CCC), Medicare CAHPS, QHP, and HOS. Assign team responsibilities, collaborate with project stakeholders, and ensure appropriate internal resources are allocated.
• Develop and maintain detailed project plans including milestones, tasks, and target/actual dates of completion. Set SMART goals, allocate resources effectively, and ensure timely execution. Track team adherence to project timelines and clear barriers to team progress, including team conflict. Escalate risks and propose mitigation strategies to leadership. 
• Lead 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. Suppo