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Job Description
HEDIS and Population Health Management Specialist 4.4 4.4 out of 5 stars New York, NY 10018 $75,000 - $85,000 a year - Full-time US Family Health Plan @ SVCMC, Inc. 9 reviews $75,000 - $85,000 a year - Full-time Job Summary Reports to Manager, HEDIS and Population Health. Assists with all aspects of the HEDIS and Population Health processes. 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 outreach to providers and members for collection and accurate data entry of medical records and other healthcare data according to
NCQA HEDIS
technical specifications; analysis of data to identify and address care gaps within the population; develop initiatives promoting and improving overall health and wellness; research and write health education literature using plain language concepts; analyze and process information collected and distribute to team members; and, maintain accurate records of all activities. Responsibilities Responsible for provider and member outreach continuously and proactively to support HEDIS and population health initiatives including but not limited to validation of contact information, validation of PCP assignments, dissemination of care gap reports, medical record retrieval, clarification of medical record information. Data Collection and Management Access/retrieve health information from internal and external repositories to ensure accurate and complete records/documentation as required to demonstrate compliance for HEDIS measure results. Enter data accurately in internal/external databases. Accurately upload and organize health information. Maintain electronic medical record and administrative files. Pull incoming medical records from fax and email buckets and save to the appropriate electronic file. Scan all incoming paper records and file to the appropriate electronic file. 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. Utilize data reports and registries to monitor quality metrics, address care gaps and develop improvement strategies. 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. Assist with design and implementation of 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 2-3 years of health education/population health experience. 2-3 years experience in government health plan operations, managed health care, and health education preferred. 1-2 years clinical experience preferred.
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), preferred Associate degree in health-related field, preferred Certified Health Education Specialist (CHES), preferred
SALARY RANGE
$75,000.00 - $85,000.00 Benefits Statement SVCMC, Inc. provides a robust benefits package that includes medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services. Employees also receive vision coverage through UnitedHealthcare Vision and dental benefits through MetLife. Basic life and disability insurance are automatically provided at no cost. All employees are eligible for commuter benefits, tuition reimbursement, and a 401(k)retirement plan with an immediate employer match that is fully vested from day one. SVCMC also offers a generous time off package, which includes vacation, 10 paid holidays, and 3 personal days. Additionally, employees have access to a comprehensive Employee Assistance Program and exclusive discounts through Working Advantage.
SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.
Pay:
$75,000.00 - $85,000.00 per year
Benefits:
401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Life insurance Paid time off Parental leave Referral program Tuition reimbursement Vision insurance
