Job Details
Senior HEDIS Manager
2025-12-09 Texas Childrens Hospital Houston,TX
Description:
About Us
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Job Description
We're searching for a Senior HEDIS Manager, someone who works well in a fast-paced setting. In this position, you'll be responsible for overseeing, maintaining, and supporting the department's active programs, which include but are not limited to: Quality Improvement Initiatives (QIAs), accreditation CAPs, quality escalations, regulatory notices, intra-departmental shared operations, accreditation oversight, and others.
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Job Duties & Responsibilities
- Leads quality strategy meetings related to assigned projects and quality initiatives
- Assures compliance with QI work plans
- Maintains effective documents of research programs to meet regulatory and accreditation standards
- Leads interactions with regulators or oversight entities including related accreditation vendors
- Leads efforts to identify best practices, Identifies potential issues, project change and scope
- Manages audits to ensure compliance with NCQA standards and regulatory initiatives
- Conducts regularly scheduled audits of the quality programs and initiatives (QIAs)
- Conducts internal audits to ensure required regulatory and accreditation metrics are being met and protocols are being followed
- Manages and reports on all clinical and non-clinical program reports and metrics on a standard frequency
- Escalates to leaders when metrics are unmet and outliers are identified. Assists with conducting root cause analysis
- Creates policies, procedures, job aids, and training materials to stand up new program
- Collaborates with Education to ensure trainings are deployed to internal and external teams
- Communicates with co-workers on joint projects and initiatives
- Incorporates ongoing changes to accreditation and regulatory documents trackers
- Bachelor's degree in healthcare, healthcare administration or related business degree required
- CPHQ - Cert-Cert Prof Healthcare Qual by The Certified Professional in Healthcare Quality preferred
- 5 years of experience in a health plan with quality improvement, health plan accreditation and or regulatory reporting required
- 3 years of experience as a program manager or related role with oversight of multiple programs required
About Us
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.