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HEDIS Manager - Falls Church, VA

UnitedHealth Group

Falls Church, VA
Job Code:
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Job Details

742067 HEDIS Manager Falls Church VA

HEDIS Manager - Falls Church, VA (742067)

Position Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


Under the direction of the Director of Quality Management, the HEDIS Manager is responsible for all aspects of the HEDIS rates production process, including working with internal data sources, external data sources, supplemental data sources and vendor partners to produce and submit the company’s HEDIS rates on an annual basis.


Primary Responsibilities:

  • Manage the validation and integration of hybrid data, supplemental data, administrative data refreshes and supporting HEDIS documentation in order to meet mandatory NCQA and data reporting requirements
  • Analyze the HEDIS results, compare them to nationally identified benchmarks
  • Responsible for assisting in the prioritization of key quality initiatives, and then monitoring and measuring the results they produce
  • Responsible for measuring the performance / outcomes and will participate on teams working to understand the barriers to strong performance, and identifying opportunities to resolve the barriers
  • Working with multiple departments within United HealthCare Quality to engage and enlist their input and recommendations related to the quality performance improvement projects
  • Assist in meeting all requirements of the HEDIS program and CAHPS survey and will work closely with relevant departments to assure understanding of the financial implications of the HEDIS and Virginia Star Rating programs

This position will work in the Falls Church, VA office with the ability to telecommute 2-3 days per week following an orientation period and manager approval.

Required Qualifications:

  • Bachelor’s Degree in a relevant subject
  • 5+ years of quality experience
  • Experience developing clinical and other improvement initiatives for both member and provider populations
  • In-depth understanding of the data sources and structures used to support production of
  • the HEDIS results
  • Basic knowledge of Medicaid regulations and NCQA Standards
  • Data management competencies, including data review and validation, importation of data into software engines, data engine configuration, and familiarity with sources and structures of data
  • Experience using Microsoft Windows programs to include Excel, PowerPoint and Outlook

Preferred Qualifications:

  • RN License for state of VA
  • Master’s Degree
  • Experience working with a health plan
  • Certification in Quality
  • Leadership experience

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.



Job Keywords: Registered Nurse, Nurse, RN, INTotal2017, Manager, Quality, Quality Improvement, Analyst, Health Care, Medicaid, Medicare, HEDIS, STARS, NCQA, Managed Care, Data Management, Manager, Quality Management, Clinical Practice Consultant, Regulatory Compliance, CMS, Clinical, Project Manager, Falls Church, Virginia, VA, UHC, UnitedHealthcare, Community and State, Public Sector

Job Details

  • Contest Number742067
  • Job TitleHEDIS Manager - Falls Church, VA
  • Job FamilyMedical and Clinical Operations
  • Business SegmentCommunity and State

Job Location Information

  • Falls Church, VA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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