HEDIS Supervisor - Orlando Fl

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Job Profile

Supervisor, Provider Engagement

Job Level

Supervisor

Description

The Supervisor develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve quality performance within the contracted working relationship with the health plan. The Supervisor works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

We are excited to share that we are in the process of changing our name to CenterWell Senior Primary Care. We expect our name transition to be complete by the first part of April 2021. We feel our new name will better reflect our commitment to deliver senior-focused primary care and reinforces our commitment to putting patients at the center of what we do every single day. The new name truly captures how we support senior health and wellness from every angle - physical, emotional and social. Join a team committed to making seniors healthier and happier every day by putting them at the center of everything we do.

Responsibilities

The HEDIS Supervisor is responsible for supervising the STAR coordinators team in all markets, sending and tracking all STAR related activities to improve HEDIS outcomes which include:


Proactive medical record collection activities, provider STAR scores, provider relations representatives' STAR scores, and Health Plan STAR scores.
Leads and manages annual HEDIS process within all markets.
Identifies, develops, and improves processes, procedures, and operations, conducts analysis, leads cross functional teams in all markets, and schedules, develops, and implements initiatives to strategically improve project processes. Secures and coordinates resources, temporary staff, space and equipment, and system requirements.
Evaluates and monitors performance and efficiency of programs and teams to ensure that implementation meets targeted timelines.
Develops strategy with organizational departments and external vendors in all markets
Synthesizes performance data, prepares presentation materials, and presents comparative complex reports to team leaders, local markets and organizational leaders.
Builds relationships with internal and external customers.
Develop and produce reports that monitor and benchmark, utilization, and other quality and performance indicators.
Monitor for adverse trends, recommend modifications, and corrective action.
Monitor team members and patients in programs offered and work with primary care physicians to ensure overall health needs of patients.

Participate in relevant health plans JOC and work all meetings; also make presentations, prepare reports, data, or other materials for presentation to leadership.
Perform medical record reviews, data collection, chart abstractions, and reporting and analysis.
Coordinates and performs medical record reviews and medical record collection for each provider to support HEDIS and quality metric reporting.
Research best practices, national and regional benchmarks, and industry standards of care.
Provide analytical support to internal departments regarding quality improvement activities.
Analysis and evaluate various sources of data to improve quality and further the goals and objectives of the organization.
Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
Manage day to day activity of the team, time sheet, PTO and productivity.

Maintain complete confidentiality of company related business.
Attend to health plans, provider, and interdepartmental calls in accordance with exceptional customer service; maintain professional and appropriate behavior (actions/verbal) at all times
Performs other duties, projects, and actions as assigned.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required
Must be ethical and possess the ability to remain impartial and objective


Required Qualifications


3 years of experience with healthcare or managed care focusing with HEDIS data analysis.
Must be able to travel at least 50% of work time
Proficient with Microsoft applications, willing to learn and develop new responsibilities and skills
Conceptual and 'big picture' understanding, Excellent analytical critical reasoning and interpersonal communication skill
Verbal and written communications skills including interpersonal skills for meeting with physicians and office staff and representing the company using diplomatic/professional demeanor.
Good organization, critical thinking, and problem solving skills. Work independently utilizing all resources available while staying within the boundaries of duties
Detail-oriented and able to work autonomously but also as a team member. Exhibit efficiency, collaboration and candor, results orientated
Should have strong communication and customer service skills and respect for confidentiality
Proven planning, preparation and presenting skills, with established knowledge of HEDIS
Demonstrated ability to manage multiple projects and meet deadlines
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Work at home and office; may require 30% to 50% in office time as needed within market (Florida). May require occasional travel to other CDO markets: TX, LA, NV, MO, KS, NC, SC or others.


Preferred Qualifications


CMA, LPN or RN
5 or more years of prior supervisory experience in a fast paced operational setting; driven by quality HEDIS metrics


Additional Information

Physical Demands


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand and/or sit for extended period of time; walk and reach with hands and arms. The employee must occasionally lift, push, pull and/or move up to 75 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.


Work Environment


The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work at home and office; may require 30% to 50% in office time as needed within market (Florida). May require occasional travel to other CDO markets: TX, LA, NV, MO, KS, NC, SC or others.


Scheduled Weekly Hours

40

Company info

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