GENERAL SUMMARY
Provides corporate oversight of Healthcare Effectiveness Data and Information Set (HEDIS) related quality improvement activities, including medical record review improvement and Coventry-wide interventions to improve HEDIS measures. Establishes strategic plans, policies, and procedures. Interfaces with all business
areas to ensure quality programs will meet or exceed guidelines and requirements.
ESSENTIAL RESPONSIBILITIES
- Ensures compliance with all State and Federal quality regulations, Coventry quality standards, and National Committee for Quality Assurance (NCQA) standards related to HEDIS reporting.
- Ensures maintenance of accurate documentation for all quality improvement activities related to HEDIS reporting, i.e., surveys, audits, peer reviews, etc.
- Collaborates with health plan Quality Improvement management staff to hold regular HEDIS improvement meetings.
- Remains current with new developments in the field of HEDIS quality improvement.
- Develops and implements new HEDIS quality improvement activities.
- Ensures all quality improvement activities are conducted according to Coventry quality standards and all appropriate data and documentation is retained.
- Ensures that quality improvement information, including the monitoring and evaluation of indicators, is collected and reported to the appropriate oversight committees.
- Directs data collection for HEDIS measures; identifies opportunities for improvement based on the HEDIS results.
- Controls expenses while meeting operational, functional, and service requirements.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience. Master’s degree preferred.
- Minimum of 5 years managed care experience with emphasis in quality improvement.
- Previous (3-5 years) HEDIS experience required.
- Minimum of 3 years management/leadership experience required.
- Certified Professional in Healthy Quality (CPHQ) preferred.
- Extensive knowledge of Quality Program implementation.
- Excellent organizational, managerial, and analytical skills required.
- Strong understanding of accreditation, federal, and state regulations/requirements.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: , , US
Organization: 10900 - CMS - STAR Corporate
Schedule: Full-time
Job Posting: 2012-10-11 00:00:00.0
Job ID: 1211758