SUMMARY
Under general supervision responsible for developing and implementing department business plans and overseeing department operations with specific responsibilities for the overall management of NCQA accreditation and HEDIS activities consistent with applicable regulations, and HPSJ goals and objectives. Work is varied and moderately complex, and requires a moderate degree of discretion and independent judgment.
SUPERVISES
ESSENTIAL FUNCTIONS
Required Skills
KNOWLEDGE, SKILLS, ABILITIES AND COMPETENCIES
Required
Knowledge of the health care industry especially the managed care industry and its products and services.
In-depth knowledge of Quality Management principles and practices.
In-depth knowledge of HEDIS measures, reporting and improvement processes, and ability to develop and implement effective programs and improvement activities
In-depth knowledge of NCQA standards, their application to quality, and ability to develop and implement effective programs and improvement activities.Strong analytical skills, including the ability to identify relevant metrics, draw conclusions and take action based on results.
In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain
Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.
Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
Decision quality: Makes good and timely decisions that keep the organization moving forward.
Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.
Ability to develop and execute goals and associated business plans.
Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.
Ensures accountability: Holds self and others accountable to meet commitments.
Drives results: Consistently achieves results, even under tough circumstances.
Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of HPSJ.
Strong oral and written communication skills, including the ability to communicate professionally and effectively with individuals and groups inside and outside of HPSJ.
Strong presentation skills, including but not limited to the ability to tailor presentations to specific audience, and identify key messages.
Collaborates: Builds partnerships and works collaboratively with others to meet shared objectives.
Persuades: Uses compelling arguments to gain the support and commitment of others.
Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
Being Resilient: Rebounds from setbacks and adversity when facing difficult situations.
Strong knowledge of change management theory, with the ability to implement effectively.
Strong project management skills and demonstrated ability to lead complex, cross functional initiatives.
Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
Strong supervisory and leadership skills, with the ability to supervise staff in a manner that maximizes employee performance and business results.
Proficient in Microsoft Office suite.
Ability to handle confidential information with appropriate discretion.
PREFERRED
Required Experience
EDUCATION AND EXPERIENCE
REQUIRED
PREFERRED
KNOWLEDGE, SKILLS, ABILITIES AND COMPETENCIES
Required
Knowledge of the health care industry especially the managed care industry and its products and services.
In-depth knowledge of Quality Management principles and practices.
In-depth knowledge of HEDIS measures, reporting and improvement processes, and ability to develop and implement effective programs and improvement activities
In-depth knowledge of NCQA standards, their application to quality, and ability to develop and implement effective programs and improvement activities.Strong analytical skills, including the ability to identify relevant metrics, draw conclusions and take action based on results.
In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain
Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.
Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
Decision quality: Makes good and timely decisions that keep the organization moving forward.
Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.
Ability to develop and execute goals and associated business plans.
Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.
Ensures accountability: Holds self and others accountable to meet commitments.
Drives results: Consistently achieves results, even under tough circumstances.
Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of HPSJ.
Strong oral and written communication skills, including the ability to communicate professionally and effectively with individuals and groups inside and outside of HPSJ.
Strong presentation skills, including but not limited to the ability to tailor presentations to specific audience, and identify key messages.
Collaborates: Builds partnerships and works collaboratively with others to meet shared objectives.
Persuades: Uses compelling arguments to gain the support and commitment of others.
Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
Being Resilient: Rebounds from setbacks and adversity when facing difficult situations.
Strong knowledge of change management theory, with the ability to implement effectively.
Strong project management skills and demonstrated ability to lead complex, cross functional initiatives.
Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
Strong supervisory and leadership skills, with the ability to supervise staff in a manner that maximizes employee performance and business results.
Proficient in Microsoft Office suite.
Ability to handle confidential information with appropriate discretion.
PREFERRED