Manager HEDIS, Stars, & ACO Data Analytics #0714
CINQCARE
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Benefits offered by this job
Job summary
Grace at Home in Washington, DC is seeking a Manager of HEDIS, Stars & ACO Data Analytics to lead quality measurement across product lines. This role ensures regulatory compliance, audit readiness, and timely submissions per NCQA, CMS, and EOHHS.
The Manager drives quality performance improvement, oversees data integration, and works in a matrix with analytics teams. 5+ years in healthcare analytics and HEDIS leadership are expected.
Qualifications
- Education and experience in health, informatics, data science, or related field.
- Experience with Excel, PowerBI, Tableau; SAS, SQL preferred.
- 5+ years in healthcare analytics; 5-10 years of HEDIS leadership experience.
- Experience leading HEDIS audits.
- Strong knowledge of HEDIS/QRS specs, Medicare Stars measures, and healthcare data systems.
Responsibilities
- Establish and execute comprehensive operational work plans for HEDIS, Medicare Stars, and ACO quality performance.
- Lead the full HEDIS lifecycle: planning, data collection, validation, rate calculation, submission, and audit.
- Ensure compliance with NCQA, CMS, Medicaid, MMP (DSNP), and ACO requirements.
- Conduct performance analysis and root cause reviews to improve quality scores and financial incentives.
- Present results and performance insights to leadership and quality committees.
- Lead initiatives to expand and optimize electronic clinical data exchange with provider EHRs, laboratory systems, and the State immunization registry.
- Improve data integrity, reporting accuracy, and operational efficiency.
- Identify and resolve data integrity issues in partnership with data governance and analytics teams.
- Partner with internal teams and external stakeholders to enhance data systems and quality outcomes.
- Manage HEDIS software vendors and coordinate audits.
- Lead RFPs, contract oversight, and audit coordination.
- Monitor specification updates and ensure submission compliance.
- Lead, mentor, and develop cross-functional analytic and clinical staff.
- Ensure training, cross-training, and timely completion of all deliverables.
- Manage performance, accountability, and cross-functional team development.
- Collaborate with Operations, Clinical, Network, Finance, Analytics, Practice Transformation, Care Management, Pharmacy, and Social Care.
Skills
Education
Tools
Job description
Grace at Home is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient's race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality - not a burden - every single day. Join us in creating a better way to care.
The Manager of HEDIS, Stars & ACO Data Analytics leads all aspects of HEDIS, Medicare Stars, and ACO quality measurement and reporting across product lines. This role ensures technical excellence, regulatory compliance, audit readiness, and timely submissions in accordance with the National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), and the Executive Office of Health and Human Services (EOHHS).
The Manager drives quality performance improvement, optimizes pay-for-performance outcomes (e.g., Medicare Stars and Quality Withhold), oversees electronic clinical data integration, and works in a matrix environment with a multidisciplinary analytics team. This position significantly impacts regulatory standing, financial performance, and national quality ratings.
- HEDIS, Stars & ACO Oversight
- Establish and execute comprehensive operational work plans for HEDIS, Medicare Stars, and ACO quality performance.
- Lead the full HEDIS lifecycle: planning, data collection, validation, rate calculation, submission, and audit.
- Ensure compliance with NCQA, CMS, Medicaid, MMP (DSNP), and ACO requirements.
- Conduct performance analysis and root cause reviews to improve quality scores and financial incentives.
- Present results and performance insights to leadership and quality committees.
- Data Strategy & Integration
- Lead initiatives to expand and optimize electronic clinical data exchange with provider EHRs, laboratory systems, and the State immunization registry.
- Improve data integrity, reporting accuracy, and operational efficiency.
- Identify and resolve data integrity issues in partnership with data governance and analytics teams.
- Partner with internal teams and external stakeholders to enhance data systems and quality outcomes.
- Vendor & Audit Management
- Manage HEDIS software vendors and work with NCQA-certified auditors(s).
- Lead RFPs, contract oversight, and audit coordination.
- Monitor specification updates and ensure submission compliance.
- Team Leadership
- Lead, mentor, and develop cross-functional analytic and clinical staff.
- Ensure training, cross-training, and timely completion of all deliverables.
- Manage performance, accountability, and cross-functional team development.
- Collaboration & Strategy
- Partner with Operations, Clinical, Network, Finance, Analytics, Practice Transformation, Care Management, Pharmacy, and Social Care.
- Support state and federal reporting requirements.
- Contribute to budgeting and strategic planning for quality analytics.
- Compliance
- Adhere to corporate compliance standards and regulatory requirements.
- Education: Bachelor's degree in health, informatics, data science, or related field required; Master's degree (MBA, MPH, MS, or related) preferred.
- Experience with Microsoft suite of tools (Excel, Word, PowerPoint, OneNote, Access etc.), PowerBI, and Tableau required; SAS, SQL, and other statistical tools preferred.
- 5+ years in healthcare analytics; 5-10 years of HEDIS leadership experience.
- Experience leading HEDIS audits.
- Strong knowledge of HEDIS/QRS specifications, Medicare Stars measures, and healthcare data systems.
- Proven team leadership and project management experience.
- Strong analytical and communication skills.
- Vendor management and process implementation experience.
Work is performed indoors in a setting with air conditioning and artificial light. Travel to and work in offices or other environments is required.
In this position you will need to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.
Travel may be required for team meetings on a quarterly basis or market visits as needed.
Grace at Home is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law.
If you require reasonable accommodation during the application or employment process, please inform the recruiter during the hiring process.
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.
- Competitive Compensation:We offer competitive salaries to attract and retain the best talent.
- 401(k) with Employer Match:Plan for your future with our 401(k) plan and a generous 4% employer match.
- Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.
- Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.
- Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you.
- Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO, holidays, and wellness time.
- Continuing Medical Education (CME) Allowance for APPs: Stay at the forefront of your field with our CME allowance.
- Commuter Benefits: Save on your commute with our commuter benefits program.
- Mileage Reimbursement: Get reimbursed for work-related travel expenses.
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