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Director, Medical Informatics

Description  Position Description:   The Director, Clinical Quality Analytics is responsible for HEDIS production and for providing data and analytic support for clinical quality programs. This position reports to the VP Clinical Quality within the Healthcare Quality and Affordability organization (HCQA).  This position partners with the Clinical Quality teams and cross functional business partners to provide data and analytical support for clinical quality projects, including opportunity identification, performance and analytical reporting, program design, impact analysis, and program evaluation.  The success of this leadership role is critical to improving quality ratings, health plan accreditation status, enhancing revenue, and reducing administrative costs of healthcare delivery. The Director, Quality Analytics manages a team of professional employees with extensive knowledge in clinical quality measurement methodology, HEDIS production, medical record review, NCQA Accreditation, Medicare Star reporting, and regulatory reporting requirements.    Essential Responsibilities: Oversee all aspects of HEDIS production, including data extraction, processing, medical record review, survey, audit, and report submission to NCQA. Oversee care gap reporting for member and provider intervention programs. Deliver contractual quality reporting to provider partners timely to improve quality ratings and for Pay for Performance programs. Identify, in collaboration with Clinical Quality teams, a set of quality of care metrics to be produced regularly.   Develop and deliver these metrics on pre-determined schedule. Analyze HEDIS data, Medicare STAR rating data, and other quality of care data to identify improvement opportunities. Provide consultation to Clinical Quality teams for quality improvement programs design and development. Support implementation of clinical quality projects, including estimating size of the population, potential impact, monitoring progress, reporting and evaluation. Provide, in collaboration with Clinical Quality teams, requirements for clinical quality data infrastructure to support clinical quality measurement and reporting activities. Monitor vendor-managed programs to ensure compliance with service level agreements and quality outcomes. Develop a unit strategic plan and a unit workplan that is tied to Departmental strategic objectives, corporate strategic objectives, and the individual objectives of reporting staff. Manage multiple projects to unit workplan. Update these management devices quarterly. Establish, develop, and maintain the internal and external relationships necessary to successfully accomplish unit objectives. Includes procurement, vendor management, and contract management. Serve as a resource to internal and external sources on related company operations. Coordinate activities with other internal departments to maximize overall efficiency and resolve conflicts. Manage team: hiring and training, performance and salary reviews, promotions and disciplinary matters for direct reporting employees. Communicate project status, progress, and outcomes to executive management. Communicate and interpret changes in relevant guidelines, policies, procedures, laws, and other related matters. Other duties as assigned.   Qualifications   Knowledge & Experience: Bachelor's degree required in health care administration, health services research, public health, epidemiology, economics, statistics, computer science or a relevant field. Master's preferred. Minimum 10 years of prior relevant experience, including 6 years of management experience. Minimum 3 years of experience leading HEDIS production and clinical quality measurement. Minimum 3 years of experience in analyzing health care insurance claims data or electronic medical record data Minimum five years of hands-on experience in data analysis tools, including but not limited to SAS, SQL, SPSS, Access, Cognos, Tableau. Strong and experienced leader who has and can successfully plan, facilitate, organize and manage a team to innovatively achieve results Mastery level knowledge and skill in analytics or health data science Strong business acumen, strategic thinking, financial analytics, and decision making skills. Critical thinking and flexibility 18002MI
Salary Range: NA
Minimum Qualification
11 - 15 years

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