Hi, we're Oscar. Were hiring a HEDIS Manager to join our Value Capture team.
Oscar is the first health insurance company built around a full stack technology platform & a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.
About the Role:
Oversee activities, resources, methods, & procedures to achieve improvement in HEDIS measures. Provide functional & technical knowledge for HEDIS across all plans. Formulate & ensure compliance with HEDIS technical specifications, policies, operating procedures, & goals.
You will report into the Director, Risk Adjustment. This is a remote role, you will work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.
- Oversee & manage the annual HEDIS submission for all lines of business.
- Oversee & ensure HEDIS data accuracy & reporting, including investigations, auditing, & improvement opportunities.
- Collaborate with internal & external stakeholders to ensure HEDIS initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members.
- Design, run, & manage the data review process to ensure accuracy & integrity of data reports to meet regulatory & operational requirements.
- Assists with preparation for HEDIS data collection, validation audits, data submission.
- In concert with the Quality Committees, assists in the design & implementation of programs & projects to improve HEDIS rates.
- Collaborates with the Data Analyst Team to obtain relevant information to track & trend quality indicators.
- Ensure accurate & timely submissions of the New York (QARR) & Covered California required filings. Respond to follow-up validation questions related to the performance measure submissions.
- Coach & lead HEDIS team to continuously improve performance & value.
- Work with other department leaders to define & implement their reporting needs regarding HEDIS & serve as a broker of available information. Assure that HEDIS staff meet the requirements of their reporting departments & that practices are following company standards.
- Maintains current knowledge of CMS & NCQA standards & has working knowledge of HEDIS, & CMS 5 Star measures & data collection.
- Other responsibilities as assigned
- Bachelor's degree in Business or Health Care or 4 years commensurate experience
- 5+ years experience with HEDIS technical specifications
- 3+ year of experience leading & supporting a team
- Ability to use business intelligence query tools, computer spreadsheet (Excel), & databases at advanced level
- 2+ years of HEDIS project management or healthcare management experience.
- Quality improvement experience.
Life at Oscar:
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.
We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.
Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (email@example.com) to make the need for an accommodation known.
Pay Transparency Policy:
Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.