Program Manager I, 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 I, Quality Data Operations, supports 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 and reporting. This includes annual audits and statutory data submissions for the associated state and federal programs. The role involves contributing to the development and maintenance of project plans, tracking timelines, and facilitating accurate and timely data submissions.

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

Job Code: PM6001

Department: Quality Analytics

Exemption Status: Non-Exempt

Location: Seattle, Hybrid

Remote Eligible: No

Direct Reports: No

 

To be successful in this role, you:

• Possess a 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.
• Have 0-3 years’ experience in program management, preferably related to HEDIS, Risk Adjustment, or general healthcare (preferred).
• Have a PMP, Agile Professional, or other formal project management certification (preferred).
• Have knowledge of program development, product development, process improvement, and program evaluation is strongly preferred.
• Have knowledge of 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:

• Oversee and support HEDIS, Prospective Medical Record Review (PMRR), CAHPS (Medicaid & Medicare), QHP, and HOS program management for annual audits. Collaborate with internal teams, third-party auditors, and vendors to ensure projects meet goals and objectives. Help ensure compliance and quality standards are met and address any issues that arise during audits to ensure successful outcomes.
• Facilitate the creation and implementation of data-driven initiatives to improve HEDIS, PMRR, Medicaid CAHPS (Adult & CCC), Medicare CAHPS, QHP, and HOS. Support the assignment of team responsibilities, collaborating with project stakeholders, and ensuring appropriate internal resources are allocated.
• Contribute to the development and maintenance of detailed project plans including milestones, tasks, and target/actual dates of completion. Support in setting SMART goals, resource allocation, and timely execution. Track team adherence to project timelines and clear barriers to team progress, including team conflict. Escalate risks and propose mitigation strategies to management. 
• Facilitate 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. Coordinate efforts with internal teams and external partners to meet regulatory requirements.
• Identify and address data issues related to improving data generation and flow throughout the organization, including reporting processes and protocols. Ensure data accuracy and completeness by cross-referencing medical records and other data sources including working with vendors to gather proof of record and conducting internal audits (Primary Source Validation). Partner with stakeholders to standardize data formats and ensure consistency for reporting.
• Discover and promote data-driven quality measurement opportunities to enhance the 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 support the development of 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.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

 

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.
• Knowledge of change management principles, practices, and methodologies.
• Analytical skills and ability to interpret data identify key trends, summarize, and communicate information in a concise and understandable manner.
• Organizational skills to ensure efficient and effective operations.
• Skilled in presenting complex data, reports, and training groups.
• Vendor management, objective targeting, and service level agreement monitoring.
• 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.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway.

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 Non-Exempt and is eligible for overtime. Based on market data, this position grade is 44 and has a 5% annual incentive target based on company, department, and individual performance goals. Salary determined at offer will be based on labor market data and a candidate's years of relevant work experience and skills relevant to the position.

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 pay.

 

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.
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.
• Frequent torso/back static position; occasional stooping, bending, and twisting.
• Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

Mental:

• Frequent decision-making. Ability to gather and assess data, determine appropriate actions, apply protocols and knowledge to unique situations, problem-solve and provide consultation.

Work Environment:

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

*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.

*The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position. Job descriptions may be updated or changed to reflect business needs.