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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

 

JOB SUMMARY

The Manager, Quality Rating Performance serves as the company expert on HEDIS, CAHPS, HOS, Medicare Advantage Star rating, Affordable Care Act (ACA) Quality Rating System and value-based contract quality performance requirements. This individual manages the Quality Rating team based in our corporate headquarters (Doral, FL), and is responsible for the Quality Rating operations and programs supporting the company’s quality rating programs across a geographically dispersed market, which includes internal and external resources.  The Manager is accountable for establishing and maintaining excellent working relationships with various teams within the company, including Clinical Operations, Information Technology, Analytics, and Payor Relations. The Manager is expected to build and manage a Quality Rating Performance program to scale for the company’s large, disperse, and growing membership.

DUTIES & RESPONSIBILITIES

The Manager, Quality Rating Performance job description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Develop strategy and manage Quality Rating program for a large ACA population, including managing of internal and external teams to deliver established program goals, specifically achieving 5-Star rating
  • Quality Rating Program management including but not limited to:
    • Support internal teams and collaborating with care partners to request, review, and abstract medical records for HEDIS, quality of care concerns, quality improvement programs, and care coordination, including electronic and paper medical records.
    • Lead HEDIS/Star/quality improvement efforts.
  • Manage team to:
    • Develop / adjust HEDIS to address evolving business requirements, including membership growth, changing measure criteria, new lines of business
    • Review and monitor Quality performance related to ACA Quality Rating System, Medicare Advantage Star rating, Medicare ACO quality rating and Value Based Agreements
  • Care Partner and provider relationship building and management including but not limited to:
    • Engage Care Partners to effectively achieve Quality Performance goals using continuous innovation and improvement through dynamic leadership.
    • Build innovative programs through interaction and collaboration with clinical and IT leaders
    • Convene and lead cross functional teams to deliver market-leading quality performance and address issues.
  • Vendor management for completion of measures
  • Other duties as assigned.

EDUCATION AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree in healthcare, science or finance is required.  An advanced degree such as a Master of Business Administration (MBA), Master of Health Administration (MHA), Master of Public Health (MPH), or equivalent degree is preferred.
  • Expertise in HEDIS, CAHPS and other common quality performance measures for ACA, MA and Medicare quality programs
  • Five (5) years of leadership experience managing Quality Rating / HEDIS for a high performing Affordable Care Act payor or provider organizations is required
  • Five (5) years of experience with clinical operations, strategy, services, and/or operations in an integrated delivery system or clinically integrated network is required
  • Ten (10) years of team or program management is required.

PROFESSIONAL COMPETENCIES

  • Clinical problem-solving technical capability
  • Proficiency within Microsoft office suite
  • EMR navigation
  • Analyzing a variety of reports
  • Relationship building
  • Understanding population health management methodology
  • Highly organized and process driven
  • Ability to manage teams across geographical locations
  • Comfortable delivering professional presentations to an audience and exceptional communication skills
  • Ability to thrive in the fast-paced environment of a rapidly growing organization
  • A willingness to think creatively and solve problems
  • Clinical background is requested
  • Ability to communicate in English and Spanish is preferred

 

 
 
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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