Buscar empleo: 48 ofertas de trabajo de remote customer service en Stockton, California (febrero 2026)

Director, HEDIS & NCQA

hace 27 días

French Camp

Job Description The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. The Health Plan of San Joaquin is now hiring an experienced and dedicated Director, HEDIS & NCQA! Location: We are looking for someone who lives in our service area. (Must reside in California.) Remote: This is a remote position; however, must be able to attend onsite meetings, and as needed for business and community purposes. What You Will Be Doing: Under general supervision responsible for providing strategic direction of Healthcare Effectiveness Data and Information Set (HEDIS), Medicare Stars, Consumer Assessment of Health Plan Providers and Systems (CAHPS) surveys, Health Outcomes Survey (HOS) and other related surveys as identified through regulatory or accrediting bodies. Provides strategic direction of the National Committee for Quality Assurance (NCQA) Health Plan and Health Equity Accreditations consistent with contractual and regulatory requirements, and Health Plan strategies and objectives. Work is varied and complex and requires a moderate to high degree of discretion and independent judgment. Supervises • HEDIS,, • Accreditation, • CAHPS, • Quality staff as assigned Our Vision: Continuously improve the health of our community. Our Mission: We provide healthcare value and advance wellness through community partnerships. Essential Functions: • Leads the development operational objectives and plans; ensures the development and implementation of associated Quality, Accreditation, HEDIS and Stars, CAHPS and HOS business plans and tactics meet CMS, DHCS, DMHC and NCQA requirements. Leads and oversees NCQA accreditation activities to ensure ongoing compliance., • Oversee the HEDIS and Stars process of monitoring, reporting and implementation of interventions for improvement., • Anticipates the need for and develops and implements relevant and effective quality management programs based on opportunities, issues and trends., • Assists Chief Medical Officer and Medical Director and Executive Director of Quality Improvement and Health Equity in identifying claims and coding issues related to HEDIS, Stars, CAHPS and HOS., • Collaborates with medical management and other departments to ensure that the Quality program meets or exceeds CMS, DHCS, DMHC and NCQA and regulatory standards., • Ensures the effective implementation of the Quality Improvement and Health Equity Transformation Program, Work Plan and Annual Evaluation, • Collaborates with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding Health Plan’s Quality Improvement program goals and activities, as well as compliance issues for HEDIS and NCQA., • Conducts or oversees the preparation, implementation and corrective action plans for internal and external quality monitoring activities to ensure practice adhere to preventive and condition management guidelines, NCQA requirements, regulatory guidelines and Health Plan criteria by overseeing the CMS, DHCS, DMHC and NCQA regulations for quality metric reporting and accreditation activities., • Acts as subject matter expert and key points of contact for vendor relationships related to NCQA, HEDIS, incentives and surveys., • Develops or oversees the development of relevant, timely and accurate internal and external quality reports, advising leadership as appropriate., • Develops, manages or advises on department budgets; implements appropriate interventions., • Develops, implements and maintains appropriate and required records, documents, policies and procedures, including contracts. Collaborates with internal and external stakeholders to ensure the collection, storage and retrieval of relevant data and information., • Leads or participates in internal and external committees as assigned., • Promotes and maintains and ensures that direct reports promote and maintain an environment that supports Health Plan’s strategy, vision, mission and values., • Hires, develops and retains, and ensures that subordinate managers hire, develop and retain, a competent staff. Non-Essential Functions • Other duties as required. What You Bring: Knowledge, Skills, Abilities and Competencies Required • Strong clinical skills., • Expert knowledge of NCQA standards and their application to quality and disease management, and ability to develop and implement effective programs and improvement activities., • Expert knowledge of CMS and HEDIS measures, and ability to develop and implement effective programs and improvement activities., • Expert knowledge of population health management best practices, and ability to develop and implement effective plans., • In-depth knowledge of and proficient skills in administering protocols for quality improvement., • In-depth knowledge of regulatory requirements pertaining to quality management., • Strong knowledge of medical management information systems and their interrelationships., • In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them., • Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions., • Strong knowledge of and ability to identify, implement, monitor and analyze relevant metrics models, and implement effective interventions based on results., • Ability to develop and manage realistic budgets., • 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 translate strategic concepts into actionable 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 achieve results, even under tough circumstances., • Very strong interpersonal skills with the ability to initiate establish and maintain effective working relationships with diverse individuals both inside and outside of Health Plan., • Very strong oral and written communication skills with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups inside and outside of Health Plan; includes the ability to effectively explain complex information., • Very strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups., • Very strong collaboration skills with demonstrated ability to create and foster a collaborative work environment., • Strong project management skills, including the ability to manage organizational-wide projects to successful conclusions., • Build networks: Effectively build formal and informal relationship networks inside and outside of the organization., • Organizational savvy: Maneuvers comfortably through complex policy, process and people- related organizational dynamics., • Persuades: Uses compelling arguments to gain the support and commitment of others., • Manages ambiguity: Operates effectively, even when things are not certain or the way forward is not clear., • Strong knowledge of change management theory, with ability to anticipate and implement effectively., • Strong customer service skills., • Demonstrated ability to articulate and support Health Plan’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff., • Ability to supervise staff, and ensure that direct reports supervise staff, in a manner that maximizes employee performance and business results, includes very strong coaching/counseling skills, including the ability to function as a mentor to management and employees., • Intermediate mathematics skills, including basic algebra., • Intermediate skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs., • Ability to speak and be understood in English., • Knowledge of the principles and practices of managed care., • Knowledge of managed healthcare as applied to government sponsored programs including Medicaid and Medicare., • Knowledge of DHCS and Medi-Cal, • Knowledge of managed care systems in a Knox-Keene licensed HMO., • In-depth knowledge of Medicaid especially as it relates to HEDIS and NCQA. What You Have: Education and Experience Required • Bachelor’s Degree in nursing, business management or related fields; and, • At least five years managing HEDIS and/or NCQA; and, • At least five years supervisory experience in a healthcare setting; or, • Master’s Degree in Nursing or other health care fields., • Experience in an HMO or managed care setting., • Experience in Quality for government sponsored programs. Licenses, Certifications Required • Current unrestricted California RN license or license relevant to the field of specialization What You Will Get: HPSJ Perks: • Competitive salary, • Robust and affordable health/dental/vision with choices in providers, • Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays), • CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan, • Two flexible spending accounts (FSAs), • Employer-Paid Term Life and AD&D Insurance, • Employer-Paid Disability Insurance, • Employer-Paid Life Assistance Program, • Health Advocacy, • Supplemental medical, legal, identity theft protection, • Access to exclusive discount mall, • Education and training reimbursement in addition to employer-paid elective learning courses., • A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do., • A shorter commute – if you’re commuting from the Central Valley to the Bay Area., • Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects. Physical Demands Frequent sitting, standing and walking, constant repetitive motion, frequent talking and listening, occasional handling of materials up to 50 lbs., closeup and distance vision requirements, occasional travel. We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit. HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics. Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.

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