Director, Quality Operations & HEDIS

Tecsa; Illinois; On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Competitive salary

Medical/Dental/Vision insurance

Employer-paid life insurance

Paid maternal leave

Paid parental leave

401(K) match

Paid time off

Employee assistance program

Job summary

Zing Health is seeking a Director of Quality Operations to lead HEDIS measurement initiatives, audits, and NCQA submissions. You will develop and execute targeted interventions to improve Stars performance, manage data abstraction, and educate providers on documentation and coding per NCQA guidelines.

Collaborating with leadership, you will ensure compliance with federal and state regulations, coordinate with the Provider Network, and drive the Quality Management Program and committee activities

Qualifications

• HEDIS reporting activities or Stars reporting experience.
• Experience overseeing HEDIS/Stars reporting and NCQA submissions.
• Knowledge of CMS Star Ratings, CAHPS, and Pharmacy measures.

Responsibilities

• Acts as SME for HEDIS measures, audits, and submissions.
• Develops interventions to improve Stars and HEDIS performance.
• Implements quality strategies and provider/member interventions.
• Administers enterprise quality and accreditation programs and audits.
• Ensures compliance with federal and state regulations.
• Manages NCQA submissions and data abstraction processes.
• Educates providers/IPAs on HEDIS documentation and coding.
• Collaborates with Provider Network to improve quality, risk adjustment, and operations.
• Develops and monitors Quality Management Program Evaluation and Work Plan.
• Leads QM committee functions and meetings.
• Performs related duties as assigned.

Skills

HEDIS experience

Medicare Stars ratings

Data analysis

Continuous quality improvement

Clinical-administrative data

Education

Bachelor’s degree in Healthcare/Public Health

Master’s degree preferred

Registered Nurse Licensure

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Microsoft PowerPoint

Job description

Zing Health is seeking a Director of Quality Operations to lead HEDIS measurement initiatives, audits, and NCQA submissions. You will develop and execute targeted interventions to improve Stars performance, manage data abstraction, and educate providers on documentation and coding per NCQA guidelines.

Collaborating with leadership, you will ensure compliance with federal and state regulations, coordinate with the Provider Network, and drive the Quality Management Program and committee activities