Manager, HEDIS, Stars, ACO Data Analytics

This is a fully remote position, open to applicants in California, +13 more states.

📋 Description

• The Manager of HEDIS, Stars & ACO Data Analytics oversees all facets of HEDIS, Medicare Stars, and ACO quality measurement and reporting across various product lines.

• This position guarantees technical excellence, adherence to regulations, audit readiness, and timely submissions in compliance 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 propels quality performance improvement, enhances pay-for-performance results (e.g., Medicare Stars and Quality Withhold), supervises electronic clinical data integration, and collaborates within a matrix environment with a multidisciplinary analytics team.

• Lead the entire HEDIS lifecycle: from planning, data collection, validation, rate calculation, to submission and audit.

• Perform performance analysis and root cause investigations to enhance quality scores and financial incentives.

• Deliver results and performance insights to leadership and quality committees.

• Collaborate with internal teams and external stakeholders to improve data systems and quality outcomes.

• Oversee HEDIS software vendors and coordinate with NCQA-certified auditors.

⛳️ Requirements

• Education: A Bachelor's degree in health, informatics, data science, or a related field is required; a Master's degree (MBA, MPH, MS, or equivalent) is preferred.

• Proficiency in the Microsoft suite of tools (Excel, Word, PowerPoint, OneNote, Access, etc.), PowerBI, and Tableau is required; familiarity with SAS, SQL, and other statistical tools is preferred.

• A minimum of 5 years in healthcare analytics; 5 to 10 years of leadership experience in HEDIS.

• Experience in leading HEDIS audits.

• In-depth knowledge of HEDIS/QRS specifications, Medicare Stars measures, and healthcare data systems.

• Demonstrated team leadership and project management capabilities.

• Strong analytical and communication skills.

• Experience in vendor management and process implementation.

🏝️ Benefits

• 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.