Electronic Clinical Data Project Lead

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

ELECTRONIC CLINICAL DATA PROJECT LEAD

Work Location: Work from Home

Position Description

As an Electronic Clinical Data Project Lead, you will be responsible for the initiation, development, implementation, validation, evaluation and sustainability of initiatives intended to enhance the availability and use of Electronic Clinical Data as it relates to UCare's strategic needs to transform quality measurement and Healthcare Effectiveness Data and Information Set (HEDIS) reporting. You will have accountability for leading project teams, coordinating, and collaborating with internal and external stakeholders, meeting project objectives and reporting to regulatory entities and leadership on project status and outcomes. You will be responsible for all project management and process improvement activities as they relate to designated projects.

The portfolio of projects may include efforts to acquire, validate and maintain meaningful external provider EMR data, assess and implement existing or new UCare vendor data opportunities and be a liaison to other internal systems configuration to better optimize and incorporate into HEDIS reporting.

Responsible for project management of complex Clinical Data acquisition and implementation activities. This includes both leading and participating as a team member on various projects. You will be responsible for overseeing and managing the project plans, timelines, relationships, and coordination with between stakeholders, preparedness for annual HEDIS reporting and providing ongoing support to sustain the results of the project.

Develop key deliverable which may include, but are not limited to, regulatory reports such as annual HEDIS ROADMAP documentation and attachments, presentations, and status updates to stakeholders. Responsible for identifying and addressing project barriers, points of risk for HEDIS validation and progress to appropriate UCare leadership.

Work with other HEDIS, Quality and Health Care Economics leaders to determine appropriate milestones and analysis for each project. This may include qualitative and quantitative review, barrier analysis, project feasibility and appropriateness, data quality assurance, data source impact reporting, soliciting input from stakeholders on priorities.

Participate in ensuring that UCare is compliant with regulatory requirements for HEDIS reporting and other quality activities. This includes clear understanding of the HEDIS Technical Specifications, including with the HEDIS audit process and any other applicable State or Federal requirements and the ability to keep updated with any changes to those requirements and modify projects as required. Initiating policy clarification support questions as needed.

During the annual HEDIS audits, this role will partner with the HEDIS Manager and HEDIS Supervisor to ensure all necessary Primary Source Verifications (PSV) are completed for any non-standard supplemental data sources.

Build and maintain alliances with internal partners for the purposes of Electronic Clinical Data exchange including Clinical Services, Health Care Economics, Providers Relations and Contracting, Stars, and external organizations, including UCare providers (primary care, specialty care, etc.), Minnesota Community Measurement, HEDIS software vendor and others as needed.

Provide education and tools to improve company knowledge and awareness of supplemental data source criteria, ECDS HEDIS measures and methodology, The Future of HEDIS, transition to Digital Quality Measures (dQM), new technologies and tools such as Natural Language Processing (NLP), as needed.

Maintain knowledge of industry trends and practices especially through the National Committee for Quality Assurance (NCQA) and HEDIS Technical Specifications.

Other projects and duties as assigned.

Education

Bachelor's degree in Business Administration, Health Care, Information Systems, Social Sciences or other related field required.  Master's Degree in health-related field preferred.

Required Experience

Two years of experience in HEDIS audit processes, including with supplemental Clinical Data; familiar with the Electronic Clinical Data Systems (ECDS) methodology and experience with validating HEDIS data sources. Familiar with health care metrics and demonstrated process improvement and project management experience. Strong verbal and written communication skills. Experience navigating a large, heavily matrixed environment across various stakeholders, including those in a virtual environment.

Preferred Experience

Formal training in project management methodologies and/or PMP certification, with initiatives that involved data transition, transformation, and incorporation. Experience working in managed care within functional areas such as Quality Management or Health Informatics. Database knowledge and development. Claims and Electronic Medical Record (EMR) systems experience. Clinical documentation and coding knowledge. Software vendor and HEDIS auditor relationship experience.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply. 

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 11/15/2023