Clinical Program Consultant Jobs (NOW HIRING)

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The HEDIS Program Consultant III is part of the HEDIS Audit and Submissions team and is primarily responsible for providing project management support and subject matter expertise for HEDIS measure production. HEDIS measures are used to improve the health of Medica members, meet regulatory and accreditation requirements, and support Medica's priority programs and partnerships.

This is a senior-level professional role with accountability for complex responsibilities and serving as a resource to others. The individual in this role possesses a strong working knowledge of HEDIS lifecycle operations and audit processes, leads and facilitates cross-functional projects that support quality measurement, develops and manages project plans, and proactively identifies and addresses barriers to keep initiatives on track. Performs other duties as assigned.

Key Accountabilities

• Assist in planning and managing multiple projects related to HEDIS/QRS measures to ensure accurate and valid data. Lead and participate in planning efforts to identify opportunities that support Medica's priorities and meet customer requirements. Build and maintain strong relationships with vendors, regulatory agencies, and internal and external stakeholders. Serve as a key point of contact for the HEDIS software vendor, HEDIS auditor, and for submission pf quality measurement data to accreditation, federal, and state regulatory bodies.
• Support the annual submission of HEDIS and QRS reporting, including the compliance audit. Coordinate with the Clinical Quality Review team and external vendors on chart review sampling and chart chase logic. Stay current on regulatory requirements and contribute to ongoing improvements in HEDIS and QRS data collection processes.
• Document and maintain team processes and project plans to track progress and ensure timelines are met. Support reporting processes that incorporate results from certified HEDIS software vendors, NCQA, CMS, state agencies, and other relevant sources.
• Collaborate across the organization with teams including Quality, Analytics, Network Management, Claims Operations, Information Technology, and Market Business Segments to monitor key quality metrics and support organizational priorities.

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5+ years of related work experience in Project Management

Preferred Qualifications

• Project management experience with HEDIS audit and submissions with demonstrated success facilitating/leading complex projects with drive and initiative.
• Knowledge of health care regulatory entities and related reporting requirements.
• Experience working with multidisciplinary teams, navigating a large organization, and professionally interacting with external vendors and provider organizations.
• Demonstrated experience documenting processes, utilizing web-based applications, and making recommendations on new procedures/projects to influence the team and goals.
• Ability to manage multiple projects and priorities; comply with tight deadlines.
• Ability to manage relationships and work collaboratively to achieve solutions and goals.
• Ability to adapt to ever-changing quality measurement application tools.
• Strong knowledge of the health care industry including but not limited to HEDIS production, health care products, payment systems, operations, policies and procedures.
• Ability to explain health care quality measures and related processes in layman's terms.
• Strong written and verbal communication skills and listening skills.
• Creative problem solving and critical thinking abilities.

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN office or Madison, WI office, on average, 3 days per week.

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.