HEDIS Manager – Performance Improvement (Remote)

Presbyterian Healthcare Services; Albuquerque (NM); Remote; USD 60,000 - 80,000; Full time

Job summary

Presbyterian Healthcare Services is seeking a Manager-Performance Improvement to oversee HEDIS and Star Quality reporting. This role requires collaboration with leadership and expertise in healthcare analytics. Candidates should have significant experience in healthcare, program management, and relevant educational qualifications. Join a dedicated team committed to improving community health outcomes in New Mexico.

Benefits

Comprehensive benefits package

Employee Wellness rewards program

Paid time off

Retirement benefits

Qualifications

• Five years of experience in healthcare required.
• Two years in HEDIS and CMS Star regulatory submissions.
• Two years of supervisory/managerial experience in healthcare.

Responsibilities

• Manage daily operations of HEDIS/Star Quality reporting.
• Collaborate with leadership to maintain Medicare Advantage Star Rating.
• Plan and execute HEDIS and Medicare Star programs.

Skills

Healthcare experience

Analytical skills

Program management

Supervisory skills

Education

Master’s degree in health or business administration

Bachelor’s degree in Business, Healthcare, or related field

Tools

Microsoft Office

Job description

Overview

Now hiring a Manager-Performance Improvement!

Presbyterian Healthcare is seeking a Manager-Performance Improvement. The Manager of Performance Improvement is responsible for managing the daily operations of HEDIS/Star Quality and Regulatory reporting within the Performance Improvement Department. This role collaborates with various entities, departments, and leadership to ensure organizational improvement efforts align with accrediting, licensing, and legal standards. The position involves program management and expertise in analytics and reporting for the annual HEDIS submission for Managed Care Organizations (MCOs), Medicare Star Program Ratings, NCQA accreditation, and compliance with regulations and contracts. The Manager works with the Director of Performance Improvement, HEDIS vendors, and Analytics Operations to ensure timely and accurate reporting to meet accreditation, regulatory, and performance targets.

How you belong matters here.

We value our employees' differences and believe in the strength of our diverse team and community.

At Presbyterian, it's not just what we do that matters, but how we do it — starting with our incredible team. From Information Technology to Food Services, our non-clinical staff make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt
• Location: Rev Hugh Cooper Admin Center
• Remote work from home, conducted within the state of New Mexico
• Work hours: Monday-Friday, weekdays
• Benefits: Comprehensive package including medical, wellness, vision, dental, paid time off, retirement, and more for full-time employees

Preferred Qualifications

• Five years of experience in healthcare
• Two years in HEDIS and CMS Star regulatory submissions
• Two years of supervisory/managerial experience in healthcare
• Master’s degree in health or business administration (e.g., public health, healthcare administration)
• Intermediate/advanced skills in Microsoft Office

Qualifications

• Bachelor’s degree in Business, Healthcare, or related field required; six years of additional experience can substitute for a degree. Master’s degree preferred.
• Minimum five years in healthcare/managed care, with experience in HEDIS/Medicare Star measurement, analytics, reporting, and forecasting
• Two years of supervisory or project management experience
• Experience presenting to leadership, clinicians, and employer groups

Responsibilities

• Collaborate with leadership to maintain an annual Medicare Advantage Star Rating of 4.0 or higher, meet Medicaid Performance Measure targets set by New Mexico HCA and other states, and sustain NCQA health plan accreditation across all lines of business.
• Work with the Director of Performance Improvement to plan, implement, and execute HEDIS and Medicare Star programs, ensuring compliance with accreditation, regulatory standards, and organizational goals.
• Provide expertise in HEDIS and CMS Star programs to ensure continuous quality improvement in QA/QI activities, aligning with Presbyterian Healthcare’s vision and values.
• Promote quality strategies and ensure adherence to policies, standards, accreditation, and regulatory requirements.

Benefits

All eligible employees receive a comprehensive benefits package including medical, dental, vision, disability, life insurance, and voluntary benefits.

Wellness: Our Employee Wellness rewards program offers engaging activities to improve health, with incentives like gift cards for participation in wellness challenges, webinars, screenings, and more.

Why work at Presbyterian? We are committed to community health improvement through initiatives like local markets and partnerships, actively working to enhance health outcomes in New Mexico.

About Presbyterian Healthcare Services: A locally owned, non-profit healthcare system established in 1908, comprising nine hospitals, a statewide health plan, and a growing medical group. We employ nearly 14,000 staff, including over 1,600 providers and 4,700 nurses. Our health plan serves over 580,000 members with Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free, tobacco-free employer with smoke-free campuses.

Maximum Offer

Up to USD $63.87 per hour.

Compensation Disclaimer

The salary range considers experience, training, internal equity, and organizational needs.