Manager HEDIS, Stars, & ACO Data Analytics #0714

Why Join Grace at Home

Grace at Home is a provider-led community-based health and care partner dedicated to improving the health and well-being of those who need care the most with a deep commitment to high-needs urban and rural communities. Our local physicians nurses and caregivers work together to serve people and the communities they live in beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible often in-home because we know a deep understanding of our patients race culture and environment is critical to delivering improved health outcomes. By empowering patients providers and caregivers with the support they need we strive to make health and care a realitynot a burdenevery single day. Join us in creating a better way to care.

Overview

The Manager of HEDIS Stars & ACO Data Analytics leads all aspects of HEDIS Medicare Stars and ACO quality measurement and reporting across product lines. This role ensures technical excellence regulatory compliance audit readiness and timely submissions in accordance with the National Committee for Quality Assurance (NCQA) Centers for Medicare & Medicaid Services (CMS) and the Executive Office of Health and Human Services (EOHHS).

The Manager drives quality performance improvement optimizes pay-for-performance outcomes (e.g. Medicare Stars and Quality Withhold) oversees electronic clinical data integration and works in a matrix environment with a multidisciplinary analytics team. This position significantly impacts regulatory standing financial performance and national quality ratings.

Duties & Responsibilities

• HEDIS Stars & ACO Oversight
  • Establish and execute comprehensive operational work plans for HEDIS Medicare Stars and ACO quality performance.
  • Lead the full HEDIS lifecycle: planning data collection validation rate calculation submission and audit.
  • Ensure compliance with NCQA CMS Medicaid MMP (DSNP) and ACO requirements.
  • Conduct performance analysis and root cause reviews to improve quality scores and financial incentives.
  • Present results and performance insights to leadership and quality committees.

• Data Strategy & Integration

  • Lead initiatives to expand and optimize electronic clinical data exchange with provider EHRs laboratory systems and the State immunization registry.
  • Improve data integrity reporting accuracy and operational efficiency.
  • Identify and resolve data integrity issues in partnership with data governance and analytics teams.
  • Partner with internal teams and external stakeholders to enhance data systems and quality outcomes.

• Vendor & Audit Management

  • Manage HEDIS software vendors and work with NCQA-certified auditors(s).
  • Lead RFPs contract oversight and audit coordination.
  • Monitor specification updates and ensure submission compliance.

• Team Leadership

  • Lead mentor and develop cross-functional analytic and clinical staff.
  • Ensure training cross-training and timely completion of all deliverables.
  • Manage performance accountability and cross-functional team development.

• Collaboration & Strategy

  • Partner with Operations Clinical Network Finance Analytics Practice Transformation Care Management Pharmacy and Social Care.
  • Support state and federal reporting requirements.
  • Contribute to budgeting and strategic planning for quality analytics.

• Compliance

  • Adhere to corporate compliance standards and regulatory requirements.

Qualifications

• Education: Bachelors degree in health informatics data science or related field required; Masters degree (MBA MPH MS or related) preferred.
• Experience with Microsoft suite of tools (Excel Word PowerPoint OneNote Access etc.) PowerBI and Tableau required; SAS SQL and other statistical tools preferred.
• 5 years in healthcare analytics; 510 years of HEDIS leadership experience.
• Experience leading HEDIS audits.
• Strong knowledge of HEDIS/QRS specifications Medicare Stars measures and healthcare data systems.
• Proven team leadership and project management experience.
• Strong analytical and communication skills.
• Vendor management and process implementation experience.

The working environment and physical requirements of the job include:

Work is performed indoors in a setting with air conditioning and artificial light. Travel to and work in offices or other environments is required.

In this position you will need to communicate with customers vendors management and other co-workers in person and over devices sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals calculator copiers and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports memos and other documents to conduct business.

Travel may be required for team meetings on a quarterly basis or market visits as needed.

Equal Opportunity & Reasonable Accommodation Statement

Grace at Home is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race color religion sex sexual orientation gender identity national origin disability veteran status or any other protected characteristic under applicable law.

If you require reasonable accommodation during the application or employment process please inform the recruiter during the hiring process.

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities duties and skills required. Management reserves the right to modify add or remove duties as necessary.

Our Benefits

Financial Well-being

• Competitive Compensation:We offer competitive salaries to attract and retain the best talent.
• 401(k) with Employer Match:Plan for your future with our 401(k) plan and a generous 4% employer match.

Health and Wellness

• Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.
• Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.
• Employer-Paid Insurance: Life Short-Term Disability (STD) and Long-Term Disability (LTD) insurance are provided at no cost to you.
• Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO holidays and wellness time.

Additional Perks

• Continuing Medical Education (CME) Allowance for APPs: Stay at the forefront of your field with our CME allowance.
• Commuter Benefits: Save on your commute with our commuter benefits program.
• Mileage Reimbursement: Get reimbursed for work-related travel expenses.