Management trainee assisting daily operations in convenience store chain. Learning skills for store management and customer service with a focus on safety and sales.
About the role
- Senior Manager of HEDIS overseeing clinical strategy and reporting intent for Denver Health Medical Plan. Managing cross-functional coordination to ensure accurate HEDIS results.
Responsibilities
- Owns overall HEDIS and CMS Core Measures clinical strategy and reporting intent across product lines
- Interprets NCQA HEDIS specifications, CMS Core Measures specifications, FAQs, and technical guidance
- Determines measure inclusion/exclusion, hybrid vs. administrative approach, and reporting decisions
- Provides clinical judgment and escalation support for complex or ambiguous scenarios
- Monitors NCQA HEDIS updates, CMS Core Measures updates, technical bulletins, FAQs, and measure changes
- Assesses the impact of upcoming HEDIS and CMS Core Measure changes on organization programs, data sources, and workflows
- Partners with IS (Information Systems) to identify and ensure changes are made outside of production season
- Partners with the MRR Manager on MRR strategy, reconciliation, and quality oversight
- Owns clinical QA/UAT for new or modified measures and other related data sources
- Owns business and clinical content of the HEDIS and CMS Core Measures Roadmap
- Works closely with IS, Product Line Managers, Population Health/QI, MRR, and vendors
Requirements
- Bachelor's degree in healthcare, public health, nursing, health administration, or related field required
- 4-6 years of experience in HEDIS, quality measurement, NCQA, or healthcare quality analytics required
- 1-3 years clinical background (RN) or equivalent clinical informatics experience required
- 3-5 years previous management experience required
- Demonstrated experience interpreting HEDIS measures and NCQA requirements
- Experience supporting or participating in HEDIS audits
- Strong written and verbal communication skills, including audit-facing communication.
Benefits
- Outstanding benefits including up to 27 paid days off per year
- Immediate retirement plan employer contribution up to 9.5%
- Generous medical plans
- Free RTD EcoPass (public transportation)
- On-site employee fitness center and wellness classes
- Childcare discount programs & exclusive perks on large brands, travel, and more
- Tuition reimbursement & assistance
- Education & development opportunities including career pathways and coaching
- Professional clinical advancement program & shared governance
- Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
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