HEDIS Operations Manager

4 weeks ago

Hanover, United States Johns Hopkins Medicine Full time

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.

What awaits you:

  • Work-life balance - This is a remote role
  • Medical, Dental, and Vision Insurance.
  • 403B Savings Plan w/employer contribution.
  • Paid Time off & Paid holidays.
  • Employee and Dependent Tuition assistance benefits.
  • Health and wellness programs and MORE

As the HEDIS Operations Manager, you’ll:

  • Oversee and manage the functions of HEDIS operations, specifically relating to efficient and accurate chart abstraction for the prospective and retrospective campaigns and supplemental data, with the goal of maximizing HEDIS performance and ensuring high-fidelity processes.
  • Be responsible for overseeing a large team of employed and contracted nursing personnel, including recruitment/onboarding, performance monitoring, and team development and training activities.
  • Drive the HEDIS workflow process improvement and oversee the year-round primary source verification process for supplemental data.
  • Cultivate a close partnership with IT/data/reporting teams and HEDIS software vendor
  • Participate and lead cross-functional collaboration with the Provider Engagement team, Quality Performance team, and other departmental stakeholders.

What you’ll bring:

  • 3+ years of management experience
  • 3+ years’ experience in clinical quality management with proven skills in process and workflow analysis, and project management in quality in a managed care organization.
  • Active Maryland Registered Nurse License or Compact Registered Nurse License in good standing; or commensurate HEDIS work experience exceeding the required 3 years.
  • Experience with NCQA and auditing.
  • Knowledge of managed care operations, HEDIS measures and reporting, project management.
  • Strong background in the understanding of HEDIS measures, clinical documentation in the EMR, HEDIS compliance audits and personnel management.
  • Analytical skills in synthesizing information from data, and communicating business requirements to IT.

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

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