Director Quality and HEDIS Data Strategy

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Job Overview

Under the general direction of the Vice President, HEDIS Strategy & Analytics, the Director of Population Health Data Strategy provides operational and strategic leadership to data acquisition and integration efforts in support of population health programs and initiatives. This position works closely with Information Systems and Provider Transformation partners across the enterprise to effectively establish and implement an omnichannel approach to achieve data interoperability within the health care ecosystem ACFC operates.

Work Arrangement

• Remote role
• Monday through Friday, 8:30 AM EST to 5:00 PM EST

Responsibilities

• Lead the business process within the organization as it relates to acquisition, ingestion and integration requirements across all ACFC partners, including but not limited to data aggregators, HIEs, providers, state registries, etc.
• Provide leadership in activities of data acquisition and integration for enterprise quality and population health management.
• Responsible for design and implementation of processes to achieve digital measure reporting.
• Support the design and implementation of Natural Language Processing as it relates to ensuring extensive application of data is made available to the solution.
• Relationship owner of Health Information Exchange integrations and opportunities for enterprise.
• Actively lead and collaborate with network and market teams to identify provider targets within the network for data acquisition and integration efforts.
• Take a prospective, opportunistic approach to assessing new EDI resources for the enterprise and each unique LOB, working to include business level prioritization and ROI criteria.
• Identify collaborative opportunities across departments and plans to further data projects.
• Partners with Information Services (IS) and key business stakeholders to align and manage an active Data Governance agenda where data is manipulated to yield actionable information for the purpose of evidence-based decision making.
• Lead the maintenance of a comprehensive catalog of clinical data assets respective to the enterprise and line of business for population health and quality.
• Actively communicate with senior leadership across business functions and teams to ensure that all parties understand current activities, successes, and barriers requiring escalation
• Advise and oversee business teams with coordination and planning of all data intake activity to ensure predictable outcomes and appropriate escalations
• Direct team in continual refinement of business processes to gain efficiencies and increase productivity
• Work with database managers and IS to insure that data is ingested and curated in a manner that insures data provenance and referential integrity are maintained
• Cultivate and sustain a high-functioning, collaborative, cohesive team
• Provide clear direction and expectations regarding team and organizational goals, activities and timelines.

Education and Experience

• Bachelor’s Degree required
• Master’s Degree in health care, public administration or related field, highly preferred
• Minimum of 8 years of progressive leadership experience in Managed Medicaid either at the market or corporate level
• Experience designing, communicating, and implementing strategic direction of Quality, Case Management, and Utilization Management Programs
• Experience spearheading data mapping and ingestion workflows for supplemental data, ensuring compliance with HEDIS technical specifications and strict QA standards across large-scale datasets
• Clinical or strong academic background with a focus on quality management

• Clinical data experience particularly with EMR (Electronic Medical Record) systems, HIE (Health Information Exchange) networks, FHIR (Fast Healthcare Interoperability Resources), and CCD (Continuity of Care Documents)

Skills

• Advanced knowledge of SQL, Python, OpenQuery, Snowflake, Azure, Databricks, Tableau, Excel
• Ability to perform supplemental data impact analysis.
• Ability to summarize complex data to senior leadership
• Understanding of clinical ontologies and code sets: SNOMED, LOINC, ICD, etc.
• Working knowledge of National Interoperability and Clinical Data Exchange standards including HL7 standards and healthcare related EDI technologies.
• Familiarity with HEDIS technical specifications.
• Proven ability to lead matrixed teams in a fast-paced enterprise environment.
• Ability to work tactically while developing strategic solutions to business problems in parallel.
• Proven ability to navigate effectively and influence at the executive level in a matrixed, multi-business enterprise.
• Demonstrated ability to interface, influence and made strategic and tactical decisions at the executive management level.
• Strong background in managed care information systems, data collection and reporting,
• High degree of operational and clinical expertise and knowledge of various managed care payment arrangements.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.