Director HEDIS & Provider Quality Incentives - Jefferson Health Plan

Job description

Job Details The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reports to help management from other departments do their jobs more effectively. The director will oversee regulatory audit activities for HEDIS and lead the efforts surrounding data collection, software development, quality review of data and rate generation. The director will be directly responsible for ensuring compliance and timely submission of the annual HEDIS project for all lines of business as well as all relevant activities to ensure successful outcome. Additionally the director will oversee the planning, forecasting, reporting and payment (around $12M annually) for both the Provider Quality Incentive Plus (QCP) and Maternity Provider Quality Incentive Plus (MQCP) Programs. The director will also be responsible for supporting the needs of the Patient Centered Medical Home (PCMH) program. Job Description: - Able to work in a constant state of alertness and safe manner - Direct the entire HEDIS and Pennsylvania EQRO process. - Oversee the plann...