Reporting to, the Senior Vice President, Medical Excellence and Clinical Solutions, the Vice President, HEDIS serves as the business owner responsible for leading the cross functional team efforts for STARS / HEDIS Optimization. This person will identify opportunities for next best actions to close health care gaps, improve quality of care and lower costs. The candidate will apply expertise in developing and utilizing key performance indicators to identify and investigate complex problems in various health care domains across several problem spaces. This position will deliver results on high-impact projects collaborating with Informatics to support data driven decision making.
This person will need to perform in a fast-paced environment, will have an operational mindset with attention to detail, and will focus on identifying value to challenging business problems. This position requires someone with strong business acumen, It is critical to have exceptional communication skills and the ability to make complex concepts simple and easy to understand. This candidate will utilize techniques from many fields including statistics, data mining, visualization, and predictive analytics.
Accountable for driving business strategy through the use of data and clinical intelligence.
Collaborates closely with Informatics team, IS and other key functional areas to develop a HEDIS, STARS strategy that utilizes data and analytics to drive execution and performance.
Oversees the development of proactive HEDIS / STARS strategies and defines processes to review and optimize interventions / initiatives to deliver excellent results of STARS and HEDIS.
Oversees and develops analytics models in collaboration with Informatics team to support HEDIS /STARS strategies to ensure high quality scores.
Oversees HEDIS abstraction team and ensures excellent results on quality scores.
Represents the business in developing data analytics for research operations and reporting and ensures data is presented for end-user consumption.
Oversees the development of proactive HEDIS / STARS strategies and defines processes to review and optimize interventions / initiatives.
Oversees the Identification and implementation of best practices for HEDIS / accreditation.
Ensures training and auditing activities support HEDIS abstraction and analytics.
Leads evaluation and identification of new capabilities and develops recommendations for "build vs. buy" decisions.
Collaborates with population health team in coordinating activities with provider network team.
Experience and Education:
Ten or more years Healthcare Leadership/Management; Clinical Program Development; Medicaid/Managed Care Experience, QUALITY and HEDIS
Ability to manage large scale projects simultaneously.
Ability to influence senior level executives.
This position requires someone with proven strong business acumen, coupled with the ability to communicate findings to both business and IT leaders in a way that can influence how the organization approaches a business challenge.
Masters degree required or equivalent experience
Amerihealth Caritas Health Plan