Clinical Solutions - Program Manager at Centauri Health Solutions, Inc. in Minneapolis, Minnesota

Job Description:

Clinical Solutions - Program Manager
Minneapolis, MN, USA Req #122

Friday, May 7, 2021

Centauri Health Solutions provides services to payors and providers in government sponsored healthcare programs, including Medicare Advantage and Medicaid. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, and data-driven solutions. Our services directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1,500 dedicated associates across the U.S. Centauri ranked No. 448 on Inc. Magazine's 2020 Inc. 500 list of the fastest-growing private companies in the U.S.

Role Summary:

The HEDIS Program Manager is accountable for managing and leading the daily activities of the Project Managers and Analysts to support HEDIS Operations. The Program Manager monitors the status of client projects and analytic requests and supports analytic requests as necessary. The Program Manager supports and oversees QA and testing of the annual updates to the HEDIS product suite including, but not limited to development of test cases, standard queries, providing SME for report development and documentation of specification changes based on NCQA HEDIS and QRS, state and custom measure technical specifications and/or requirements. The Program Manager is responsible for overseeing rate reviews and analysis, root cause analysis of data issues and client outliers, and mentoring/training the project management and analyst team on these items. The Program Manager also develops technical documents related to technical specifications, application functionality, issue briefs and internal training manuals and reference guides as necessary. The Program Manager will demonstrate strong understanding of measure code development, data analytic and presentation skills as well as display good judgment and critical thinking to address business problems.

Role Responsibilities:

• Oversee daily activities of the Project Managers and Analysts
• Develop annual team goals in partnership with VP Clinical Solutions, conduct annual and mid-year reviews, provide training and mentoring to Project Managers and Analysts
• Provide documentation of annual updates to Measure Engine based on NCQA HEDIS and QRS measure specifications for certification.
• Manage communication with internal team and leadership of changes regarding client configuration, measure specifications and application functionality including results of impact analysis specific to the changes.
• Report progress, obstacles, etc. to Senior Management on a regular basis.
• Anticipate annual measure change risks and formulates actions to mitigate risk, modify queries, and recommend modifications and enhancements to HEDIS product suite as appropriate.
• Oversee rate review and analysis, including root cause analysis for client outliers and data issues.
• Provide analytic support for audit questions and requirements, including Volume 5 audit queries.
• Provide subject matter expertise for reports and conduct/oversee root cause analysis for issues with existing report content and creating ad hoc report substitutions when possible and appropriate.
• Develop in internal training for analysts/project managers to perform data mining and root cause analysis on client data.
• Collaborate with the project and development teams on long term improvements, testing processes and application features, including the addition of measures, reports, and functionality.
• Lead creation of SQL queries and tools to assist and streamline data mining and analysis for project team.
• Oversee annual HEDIS debrief process and documentation
• Support annual HEDIS project evaluation process including identification of improvement/enhancement opportunities
• Manage and develop technical documents related to measure configuration, technical specifications, application functionality, issue briefs, internal training manuals and reference guides as necessary.
• Understand and agree to role-specific information security access and responsibilities
• Ensure safety and confidentiality of data and systems by adhering to the organizations information security policies
• Read, understand and agree to security policies and complete all annual security and compliance training

Role Requirements:

• 7+ years' experience in Healthcare, Quality and technology with strong HEDIS subject matter expertise
• A proven track record of progressively responsible experience
• Strong understanding of quality measure calculation development
• Extensive knowledge of and experience with HEDIS quality measurement and development of certified measures, including a deep understanding of Technical Specifications and relational databases.
• Excellent analytical and modeling skills.
• Adept at partnership and collaboration both internally and externally.
• Strong one-on-one, small group and large group communication skills.
• Excellent judgment, critical thinking and decision-making abilities.
• Possesses strong process management and business planning skills.
• Possesses strong communication and relationship building skills.
• Ability to work effectively as part of a team when an interdisciplinary approach is required.
• Deep understanding of Healthcare and Technology industries.
• Comprehensive HEDIS knowledge and expertise including medical record retrieval and abstraction, data management, reporting and monitoring
• Expert understanding of HEDIS data integrity, analytics and reporting.
• Working knowledge of both the medical and business side of healthcare operations.
• Knowledge of related regulations including HIPAA, CMS and other related regulations.
• All elements of project management and implementation
• Highly proficient in MS Office Suite and SQL with extensive knowledge and experience with relational databases

We believe strongly in providing employees a rewarding work environment in which to grow, excel and achieve personal as well as professional goals. We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities.
Other details

• Pay Type Salary

• Minneapolis, MN, USA