Program Manager II, Quality Data Operations

 Who we are

Community Health Plan of Washington is
an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

·         Strive to apply an equity
lens to all our work. 

·         Reduce health disparities. 

·         Become an anti-racist organization 

·         Create an equitable
work environment. 

About the Role

The Program Manager II, Quality Data Operations is responsible for overseeing the Healthcare Effectiveness Data Information Set (HEDIS), Consumer Assessment of Healthcare Providers (CAHPS), Qualified Health Plan (QHP), and Health Outcomes Survey (HOS) programs’ data collection, reporting and analytics. This includes annual audits and statutory data submissions for the associated state and federal programs. The role involves developing and maintaining project plans, tracking timelines, facilitating accurate and timely data submissions, and clearing barriers to team progress. The Program Manager II is also responsible for identifying and triaging data issues, identifying and driving data quality measurement opportunities, and maintaining effective communication with internal and external stakeholders, including managing contracted vendor performance, and evaluating new vendor opportunities. The Program Manager II collaborates with various departments to enhance operational readiness and performance measurement, while also providing status reporting and communications to various levels of leadership.

Reports To: Manager, HEDIS/CAHPS/QHP Operations & Performance Measurement

Job Code: PM6002

Department: Quality Analytics

Exemption Status: Exempt

Location: Seattle, Main Office

Remote Eligible: Hybrid

Direct Reports: N/A

 

To be successful in this role, you:

• Bachelor’s degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or other relevant academic field, or an equivalent combination of education and/or highly relevant experience.
• 3+ years’ experience in program management, preferably related to HEDIS, Risk Adjustment, or general healthcare (preferred).
• PMP, Agile Professional, or other formal project management certification (preferred).
• Experience in program development, product development, process improvement, and evaluation is strongly preferred.
• Have experience with Community Health Centers (CHC), Federally Qualified Health Centers (FQHC), or other healthcare systems focused on those with low income and/or barriers to equitable healthcare (preferred).
• Have experience with Microsoft Office Suite (Word, Excel, Outlook, and Internet Explorer) and Adobe Acrobat, including comfort with pivot tables at a minimum. Experience with SharePoint, Confluence, JIRA, or Smartsheet is preferred.

 

Essential Functions and Roles and Responsibilities:

• Serve as a subject matter expert for HEDIS, Prospective Medical Record Review (PMRR), CAHPS (Medicaid & Medicare), QHP, and HOS program management for annual audits. Work directly with internal teams, third-party auditors, and vendors to ensure projects meet goals and objectives. Provide expert guidance on compliance and quality standards and address any issues that arise during audits to ensure successful outcomes.
• Develop, implement, lead, and manage projects and data-driven initiatives to improve HEDIS, PMRR, Medicaid CAHPS (Adult & CCC), Medicare CAHPS, QHP, and HOS. Assign team responsibilities, collaborate with project stakeholders, and ensure appropriate internal resources are allocated.
• Develop and maintain detailed project plans including milestones, tasks, and target/actual dates of completion. Set SMART goals, allocate resources effectively, and ensure timely execution. Track team adherence to project timelines and clear barriers to team progress, including team conflict. Escalate risks and propose mitigation strategies to leadership. 
• Lead the end-to-end processes of data submission to regulatory bodies ensuring accurate and complete critical statutory data (HEDIS, CAHPS, QHP & HOS). Collaborate with various departments to ensure all necessary resources and processes are in place for accurate and timely data submissions. Support operational readiness by coordinating with internal teams and external partners to meet regulatory requirements.
• Lead the identification of data efforts and issues related to improving data generation and flow throughout the organization, including reporting process and protocol. Ensure data accuracy and completeness by cross-referencing with medical records and other data sources including working with vendors to gather proof of record and conducting internal audits (Primary Source Validation). Collaborate with stakeholders to standardize data formats and ensure consistency for reporting.
• Lead the identification of data-driven quality measurement opportunities, enhancing rate performance. Analyze data to identify trends and areas for improvement. Communicate opportunities to business owners and work with them to implement strategies that enhance quality and performance metrics.
• Develop program knowledge to support key strategic opportunities and improvement strategies. Stay informed about industry trends, regulatory changes, and best practices. Use this knowledge to identify strategic opportunities and develop improvement strategies that align with organizational goals.
• Maintain effective communication with stakeholders, ensuring regular updates on project status, issues, and recovery plans. Establish and nurture professional relationships with key partners to facilitate collaboration and support. Ensure all stakeholders are informed and engaged throughout the project lifecycle.

 

Knowledge, Skills, and Abilities:

• Knowledge of Medicaid, Medicare and/or Exchange principles and practices pertaining to any of the following: Centers for Medicaid and Medicare (CMS), National Committee for Quality Assurance (NCQA), Pharmacy Quality Alliance (PQA), Milliman and/or Acumen with emphasis in quality improvement.
• Strong analytical skills and ability to interpret data identify key trends, summarize, and communicate information in a concise and understandable manner.
• Strong vendor management, objective targeting, and service level agreement monitoring.
• Knowledge of and experience leveraging change management principles, practices, and methodologies.
• Skilled in adapting to dynamic environments and juggling multiple tasks and projects to meet operational demands driven by business needs.
• Ability to work both independently without supervision and collaboratively as part of a team.
• Ability to work with a high degree of accuracy and meet established deadlines.
• Maintain strong organizational skills to ensure efficient and effective operations.
• Strong skills in presenting complex data, reports, and training to groups.

 

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

 

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is (66) (see full range below) and has a (10%) annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents: 

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

 

Sensory/Physical/Mental Requirements:

Sensory*:

Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

 

Physical*:

• Extended periods of sitting, computer use, talking, and possibly standing

 

Mental:

Frequent decision-making.

 

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.