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Wellmark - Des Moines Clinical Quality Manager - HEDIS in Des Moines, Iowa

Help us lead change and transform the member experience

The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We’re embarking on a journey to help our members navigate and use the system in order to help them make clear, informed decisions, and we’re also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.

Use your strengths as Clinical Quality Manager - HEDIS

In this key individual contributor role, you will provide day-to-day management and oversight for Wellmark’s HEDIS clinical quality program and HEDIS team. You will lead all components of the HEDIS program in accordance with NCQA. This includes, but is not limited to, data management and reporting of measures to internal and external audiences as appropriate, coordinating HEDIS audits, and presenting results in reports and/ or dashboards that are easily consumable. You will also serves as a subject matter expert for the HEDIS vendor tool and maintains contractual and operational oversight of all HEDIS vendors.

Ideal candidates are excellent strategic thinkers with passion for using and analyzing data. They love tackling complex work and enjoy opportunities to lead projects, make sense of policy, and conduct research. Being on point for key deliverables, prioritizing work, and collaborating across the business makes for a good day. Sound like a fit? Review the qualifications below and consider applying today!

Required:

  • Completion of an accredited nursing program.

  • Active and Unrestricted Registered Nurse (RN) license in Iowa or South Dakota (individual must be licensed in the state in which they reside).

  • 3+ years of experience analyzing health care quality related data (e.g., HEDIS, ACO, quality improvement) in a health insurance, clinical operations, managed care, or related government setting. Experience should also reflect an ability to think strategically and ensure HEDIS program success.

  • Excellent analytical skills, data management capabilities, and strong attention to detail. Technical aptitude to learn new data management and analysis tools or methodologies quickly.

  • Effective consultation and critical thinking skills. Ability to review data and provide measurable outcomes and trend measures to support and influence business decisions.

  • Strong written and verbal communications skills with the ability to share technical insights and recommendations with varying stakeholder audiences, including external vendors. Adapts communication based on audience.

  • Self-starter able to produce quality results based off of sound decision making skills. Effective time management of tasks with flexibility and adaptability to change.

  • Collaborative approach to work with ability to partner with different business areas.

Preferred:

  • Bachelor’s or Master’s degree in nursing.

a. Provide day-to-day management and oversight for Wellmark’s HEDIS clinical quality program and HEDIS team. Will lead all components of the HEDIS program in accordance with NCQA. includes, but is not limited to, data management and reporting of measures to internal and external audiences as appropriate, coordinating HEDIS audits, and presenting results in reports and/or dashboards that are easily consumable.

b. Partner with internal stakeholders and/or external vendors for the definition, design, implementation, and maintenance of data files, data marts and data extracts to ensure critical business requirements, accreditation and other business needs are met and maintained. Accountable for the integrity of the data. Assist the Team Leader in the contracting process with external vendors.

c. Lead the development and maintenance of integrated comprehensive actionable reporting and provide consultative and analytical expertise to internal and external stakeholders, including Wellmark leadership. Adhere to established data governance standards, HEDIS, NCQA and FEP requirements and other required standards and processes.

d. Responsible for analysis of health data (i.e. HEDIS) and to extract, analyze, interpret, integrate, and report using internal and external data sources to inform quality development and improvement plans. Draw conclusions and support recommendations made to stakeholders that will help to achieve overall enterprise quality goals.

e. Acts as lead on HEDIS and other health metrics for program and other enterprise strategies related to quality. Applies complex qualitative and quantitative analysis techniques to interpret data in support of the Quality Program, Accreditation and the Quality Committee.

f. Collaborate with the Business Analytics teams in meeting the quality reporting needs of Wellmark and stakeholders. Work closely to integrate and support cross-functional quality initiatives and programs with a focus on supporting Wellmark’s Quality Program goals.

g. In collaboration and partnership with the Team Leader, assist in the evaluation of quality management strategies or initiatives and manage multiple tasks, data collection and reporting initiatives while supporting participation in cross-functional projects and other initiatives.

h. Independently complete reports, dashboards and analytical tasks. Assist with and support complex reports and analytic tasks including basic statistical analysis, what if analyses, and other analytical techniques.

i. Other duties as assigned.

Requisition ID: 214713

REQUIRES NON-COMPETE?: No

External Company Name: Wellmark Blue Cross and Blue Shield

External Company URL: www.wellmark.com

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