Director HEDIS & Quality Improvement Analytics

Medical Mutual; Brooklyn (OH); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

401(k) with company match

Employee bonus program

Tuition reimbursement

Gym membership reimbursement

Job summary

Medical Mutual is seeking a Director HEDIS & Quality Improvement Analytics for a hybrid remote role based in Brooklyn, OH. This position will lead operations and analytics for HEDIS and quality improvement, ensuring compliance with regulatory standards and managing submissions.

In this role, you will direct a team focused on data analysis, reporting, and operational enhancements. The ideal candidate will have strong leadership skills and extensive experience in health plan analytics.

Qualifications

• 8 years of experience in health plan or health care analytics with leadership experience.
• Comprehensive knowledge of HEDIS cycle.
• Proficiency with NCQA-certified HEDIS software.

Responsibilities

• Directs the HEDIS annual submission process and manages work plans.
• Leads strategic planning based on reporting to improve HEDIS scores.
• Builds relationships with internal and external customers.

Skills

HEDIS expertise

Analytic programming languages (SAS, SQL)

Data visualization tools (Tableau, Cognos)

Project management

Leadership

Education

Bachelor's Degree in Business or Health Care Administration

Master's degree

Job description

Hybrid remote role based out of the Brooklyn, OH office, with the Director HEDIS & Quality Improvement Analytics expected to work onsite on four designated in‑office days each week.

Director HEDIS & Quality Improvement Analytics

Job Summary

Directs operations and staff engaged in Healthcare Effectiveness Data and Information Set (HEDIS) and clinical quality improvement analytics and supplemental data functions. Ensures adherence to reporting requirements of the National Committee on Quality Assurance (NCQA) and regulatory agencies. Leverages and delivers clinical quality improvement management data and reporting that support the health plan's strategies, goals, and initiatives for all lines of business (Commercial, Marketplace, Medicare Advantage, and Stars).

Responsibilities

• Directs the HEDIS annual submission process. Develops and manages work plans; establishes and ensures timelines are adhered to, assigns responsibilities, and monitors and reports progress to internal stakeholders.
• Directs and coordinates the preparation of the HEDIS roadmap including all data sources and exchanges with vendors and providers.
• Leads strategic planning based on reporting and year‑over‑year comparisons for continual process improvement of Stars and HEDIS scores and overall accreditation for all lines of business.
• Mea­ses trends, discusses reasoning behind trend, and calls out any significant changes.
• Leads the process for defining operational improvements within the health plan based on HEDIS performance following the annual HEDIS audit.
• Builds relationships with internal and external customers. Communicates progress and results through presentations to key stakeholders, including senior leadership.
• Shows at Joint Operating Committee (JOC) meetings with Physicians and Administrative Health System leadership.
• Leads strategic projects related to the use of supplemental data (internal, external and in the vendor space) to enhance performance for all lines of business for HEDIS improvement results and overall HealthPlan scores.
• Enhances reporting for Member Assistance Program (MAP) members and other clinical areas to identify assigned staff to cases for tracking and care gap closure opportunities.
• Collaborates with internal stakeholders to ensure data warehouse architecture development and utilization.
• Directs the supplemental data team responsible for Extraction, Transformation and Loading (ETL) including the design, building, testing, and maintaining of ETL jobs.
• Oversees the translation of functional ETL requirements into technical design elements to be utilized by internal teams for managing and maintaining supplemental data.
• Directs external client relationships with regards to supplemental data including providing technical specifications to clients (SFTP set‑up, file layout, etc.), establishing a cadence for data submission, monitoring the processing of data files, and working with the client to improve the impact of supplemental data on HEDIS measures.
• Develops and maintains Value‑Based Consulting (VBC) reporting to support the VBC contracting outcomes and team.
• Participates in contracting calls with Provider groups to supply details on supplemental data files and care gap measures scores. Collaborates with provider groups key contacts to enhance the data files.
• Manages staff developing quality measurement analytics and reporting for internal use and regulatory submissions including staffing, training and development and performance management. Ensures deliverables are reliable, valid, and actionable.
• Performs other duties as assigned.

Education and Experience

• Bachelor's Degree in Business or Health Care Administration, Public Health, or a related field.
• Master's degree preferred.
• 8 years of experience in health plan or health care analytics which includes HEDIS and clinical quality improvement, 5 years of which is in a leadership capacity.

Technical Skills and Knowledge

• Comprehensive knowledge of the end‑to‑end HEDIS cycle (e.g., abstraction, data submission, audit, etc.) and the ability to apply advanced concepts to Company operations.
• Expert knowledge of and proficiency with NCQA‑certified HEDIS software.
• Extensive knowledge of NCQA and CMS measurement, reporting and regulatory requirements.
• Intermediate to advanced knowledge of and proficiency with analytic programming languages and data visualization tools, including SAS, SQL, Cognos, Tableau, and Microsoft Visual Studio.
• Familiarity with multiple data source formats, including delimited flat files, web services, and SharePoint list XML.

Benefits

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

Great Place to Work

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on‑site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On‑site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance – insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self‑help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

Equal Opportunity Employer

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.