HEDIS and Population Health Management Specialist

Job Summary

Reports to Director, HEDIS and Population Health. Identifies opportunities to improve enrolled beneficiary health, improve utilization of the Plan’s preventative health benefit and improve HEDIS rates in accordance with TRICARE Program, NCQA HEDIS, and Plan requirements.  Primary responsibilities include collection and analysis of data to identify and address care gaps within the population, development of initiatives promoting and improving overall health and wellness, research and writing of health education literature using plain language concepts, and maintenance of accurate records of all activities.

Responsibilities 

Data Collection and Management:

• Develop and maintain data collection and reporting tools to analyze population health information. Evaluate data for trends. Identify systematic patterns of access to preventative healthcare and care gaps to recommend and develop improvement plans. Use proven statistical and analytical methodologies/tools that drive improvement.  
• Create and maintain databases to track outcomes.
• Utilize data reports and registries to monitor quality metrics, address care gaps and develop improvement strategies.
• Access health information from internal and external repositories to ensure accurate and complete records/documentation as required to demonstrate compliance for HEDIS measure results.
• Accurately upload and organize health information.
• Conduct outreach to healthcare providers to secure medical records on a proactive and ongoing basis, to close gaps in care.

Responsibilities Continued:

• Timely and accurate reporting of program activities and progress towards goals in accordance with TRICARE and Plan reporting requirements. Thoroughly and accurately document all PH activities in appropriate systems, including ongoing tracking and interval reporting of progress on initiatives and interventions. 
• Ability and inclination to adopt technology to maximize efficiency. Leverage state of the art IT solutions as part of furthering Population Health (PH) Program goals. Manage administrative access to data platforms. Create and maintain databases/record-keeping to track outcomes. 
• Utilize a whole-person focus that utilizes evidence-based practices, person-centered interventions based on identified risk and needs, and incorporates community resources within the constraints and benefits of the current TRICARE program. 
• Design and implement disease prevention and health promotion services that address the full spectrum of lifestyle risks, promote healthy behaviors to improve the health of the population, encourage self management of health behaviors, and continually evolve to incorporate and maintain healthy lifestyle changes in the Plan population.
• Develop and manage collaborative relationships with internal stakeholders, vendors, provider groups, and community partners, including plans for provider communication and integration and vendor performance. 
• Identify and implement initiatives to improve outcomes when metrics/standards are not met.
• Effectively meet strict deadlines.
• Support the department’s leadership with management of the HEDIS and PH programs, data collection, analysis, and other PH activities as assigned. 
• Perform other duties as assigned or required.  
• Aware of the potential for fraud and waste and how to report suspected fraudulent activity. 

Supervisory Responsibility

None

Experience 

• Minimum 5 years of health education/population health experience. Minimum 3 years of experience in government health plan operations, managed health care, and health education. 
• Minimum 2 years of clinical experience.

Skills/Competencies

• Communications: Effective verbal and written communication skills to convey health information, ideas, expectations, and information to internal/external stakeholders and project collaborators. Able to work collaboratively with different teams and different team members.  
• Statistical analysis:  Intermediate data collection and statistical analysis expertise including data interpretation.
• Problem-solving: Able to identify and solve problems that may arise during a project. Adaptable and able to adjust plans/strategies to keep project on track to completion. Analytical mindset with excellent organizational and problem-solving skills. Aware of areas of non-compliance and able to recommend process improvement initiatives. 
• Strong health education research skills.
• Ability to work both independently and as a team member. Able to meet deadlines.  
• Proficient in Microsoft Office, including but not limited to Excel, Outlook, PowerPoint and Word. 
• Experience in Access and Visio a plus. Ability and inclination to adopt technology to maximize efficiency.
• Understanding of medical terminology, anatomy, physiology and concepts of disease and health. 
• Fundamental knowledge of ICD-10, CPT and HCPCS coding.
• Excellent customer service skills.
• Manages assigned workload in accordance with established performance metrics. 

Education/Certifications/License 

• Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN), required 
• Associate degree in health-related field, preferred
• Certified Health Education Specialist (CHES), preferred

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - QUALIFIED APPLICANTS WILL RECEIVE EQUAL CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO PROTECTED VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW