IT HEDIS & Analytics Manager

Sentara Health Plans; Norfolk, Northern (VA, KY); Hybrid; USD 117,000 - 217,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Tuition assistance

401k/403B with employer match

Job summary

Sentara Health Plans seeks an IT HEDIS Manager to lead technology, data integration, and platform operations for the HEDIS program. You will manage ETL developers and production staff, coordinating with IT, Quality, vendors, audits, and project stakeholders to support data feeds, validation, and reporting.

The role supports a major engine replacement initiative, migrating from Inovalon/Cotiviti to a future-state platform with Arcadia involvement, ensuring NCQA-related functionality and data

Qualifications

• Seven or more years in healthcare data, payer technology, analytics, data warehousing, quality measurement, HEDIS operations, or related IT functions.
• Three or more years of leadership experience managing ETL, data engineering, technical operations, analytics, production support, or similar teams, including direct oversight of staff.
• Experience supporting HEDIS data processing, reporting, validation, audits, quality-measurement platforms, or HEDIS engine implementation, replacement, migration, or parallel-validation activities.
• Strong knowledge of payer enrollment, claims, encounters, pharmacy, provider, laboratory, clinical, supplemental data, ETL, SQL, data warehouses, Databricks, file-based integrations, APIs, testing, reconciliation, and production support.
• Experience working with HEDIS-related vendors or platforms such as Arcadia, Cotiviti, Inovalon, or comparable systems, with the ability to communicate technical issues clearly to business, vendor, audit, project, and executive stakeholders.

Responsibilities

• Lead the IT functions for the HEDIS program, including technology, data integration, platform operations, and technical validation.
• Manage ETL developers and operational support staff while partnering with HEDIS, Quality, business, vendor, audit, and project stakeholders.
• Oversee HEDIS data feeds, production operations, platform support, data-quality controls, technical documentation, vendor coordination, audit support, and reporting deliverables.
• Support the major HEDIS engine replacement initiative, including migration to a future-state platform with Arcadia involvement.
• Coordinate with vendors and audits across IT, Quality and business to ensure compliant, timely deliverables.

Skills

HEDIS data knowledge

Leadership

ETL

Education

Bachelor's degree in IT/CS/Data Management/Healthcare Administration

Tools

Arcadia

Cotiviti

Inovalon

Databricks

SQL

Job description

City/State Norfolk, VA

Work Shift First (Days)

Overview

The IT HEDIS Manager is responsible for leading the technology, data integration, platform operations, and technical validation functions that support the organization’s HEDIS program. This role manages ETL developers and operational support staff while serving as a key IT partner to HEDIS, Quality, business, vendor, audit, and project stakeholders. The manager oversees HEDIS data feeds, production operations, platform support, data-quality controls, technical documentation, vendor coordination, audit support, and reporting deliverables. This role will also support a major HEDIS engine replacement initiative, including migration from the current Inovalon/Cotiviti environment to a future-state platform with Arcadia supporting portions of HEDIS and NCQA-related functionality.

Education

Education Bachelor’s degree in Information Technology, Computer Science, Data Management, Healthcare Administration, or a related field (Preferred) or 7+ years relevant experience may be accepted in lieu of degree

Certification/Licensure

Certification/Licensure No specific certification or licensure requirements

Experience

• Seven or more years of experience in healthcare data, payer technology, analytics, data warehousing, quality measurement, HEDIS operations, or related IT functions (required )
• Three or more years of leadership experience managing ETL, data engineering, technical operations, analytics, production support, or similar teams, including direct oversight of staff (required)
• Experience supporting HEDIS data processing, reporting, validation, audits, quality-measurement platforms, or HEDIS engine implementation, replacement, migration, or parallel-validation activities(Required)
• Strong knowledge of payer enrollment, claims, encounters, pharmacy, provider, laboratory, clinical, supplemental data, ETL, SQL, data warehouses, Databricks, file-based integrations, APIs, testing, reconciliation, and production support.
• Experience working with HEDIS-related vendors or platforms such as Arcadia, Cotiviti, Inovalon, or comparable systems, with the ability to communicate technical issues clearly to business, vendor, audit, project, and executive stakeholders.(preferred)
• Experience supporting an NCQA HEDIS compliance audit.(preferred)
• Knowledge of ECDS, digital HEDIS measures, FHIR, HIE integration, and clinical-data exchange

Keywords

Keywords: LinkedIn , HEDIS, Cotiviti, Innovalan,Arcadia

Compensation

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:$116,729.60-$216,777.60. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Benefits

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Equal Opportunity

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission "to improve health every day," this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

About Sentara

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara "Employer of Choice" for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!