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Vice President - HEDIS Line of Business Operations - Virtual

UnitedHealth Group

Los Angeles, CA
Job Code:
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Job Details

Vice President - HEDIS Line of Business Operations - Virtual(Job Number:730329)

The HEDIS Line of Business (LOB) Director/VP is responsible for leading staff for an entire LOB (M&R, C&S or E&I) to develop, translate and execute the annual HEDIS strategy and process with excellence. Demonstrated HEDIS subject matter expertise is essential to job performance. The Leader is involved in all of the highly complex and critical elements supporting HEDIS operations.


Primary Responsibilities:

  • Data Preparation / Capture
  • Administrative Data (Claims, Encounters & Supplemental Data)
  • Hybrid Chart Chase / Collection
  • Audits
  • Abstraction /Rate Maximization
  • Vendor Management
  • Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience
  • Day to day work varies based on time of year, with overarching goal of developing strategies and organizing processes to increase collection of member compliant information resulting in improved HEDIS rates
  • The position focuses on both pre-season data collection and year round data collection and utilization
  • The core work during HEDIS collection season includes leading team in medical record collection and abstraction, Vendor Management, complete non-compliant review, and rate maximization
  • Employs focused Line of Business (LOB) strategy, providing a priority measure approach to HEDIS data collection and GAP closure for each reporting population and is able to readily summarize LOB status of the project in relation to LOB goals
  • Position is responsible for providing direction and guidance on clinical quality improvement and management programs including accreditation
  • Leader is responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools
  • This work is critical to the success of our organization as the results directly impact the profitability of our organization
  • Set, plan and execute annual HEDIS strategy for a specific LOB as a HEDIS subject matter expert (including but not limited to process, audit requirements, submission timelines, NCQA requirements, National vs State level audit requirements)
  • Identifying and implement strategies based on trends that impact collection, abstraction or compliance
  • Works closely with senior leaders and across multiple levels of management of United’s Healthcare’s LOBs to align, translate and deploy strategies for successful HEDIS collection and reporting
  • Work with your peers within HEDIS managing the other LOBs to collaborate where appropriate/possible
  • Ensure adherence across all processes, to Compliance requirements for applicable LOB, including reporting and improvement of HEDIS and HEDIS-like state specific measures, collaboration with other HEDIS departments on identification and development of operational quality improvements
  • Direct management oversight of business processes to improve compliance, external data collection & internal data collection, while optimizing quality and efficiency in support of organization objectives
  • Builds and maintains alliances with customers, business partners, consultants, providers to meet/exceed business objectives.
  • Key Processes - Hybrid Chart Chase, Abstraction, Administrative Data (Claims, Encounters & Supplemental Data), Data Preparation, Capture, Process Improvement, Pre-Season and Year-Round Data
  • Plays leadership role in various aspects of key assignments & operational strategies
  • Pursue continuous improvement in customer satisfaction, operational/performance metrics, processes, and competence of staff and cost reduction.
  • Develops and implements regional/national operational plans in alignment with organizational population health strategies to achieve quality and affordability targets.
  • Collaboration with DAR, Trainers, Regional Market staff, Vendor Consultants, Strategic Partners, Auditors and OptumInsight on all HEDIS deliverables
  • Accountable for overall project activities
  • Ensure State-specific deliverables and customer measures are met, where applicable
  • Successfully recruits and develops staff to continuously improve their overall performance, effectiveness and engagement.
  • Set, plan and assist the HEDIS managers in the contractor staff strategy for interviewing, hiring and onboarding
  • Directs resources in most efficient manner to meet organizational objectives.
  • Communicate project status along with risks, successes and mitigation plans


  • Demonstrated ability to manage and develop people while prioritizing deliverables when faced with competing priorities
  • Proven ability to influence course of action with diplomacy and tact when others are directly accountable for outcomes
  • Passion for customers and a demonstrated focus on customer experience
  • Energy, motivation, and commitment to drive to results in a challenging, fast-paced environment
  • Demonstrated ability to meet commitments, build consensus, negotiate resolutions, and garner respect from other teams
  • Diplomatic with strong negotiation and conflict resolution skills

Job Med & Clin Ops-General Mgmt
Primary Location US-CA-Los Angeles
Other Location US-NY-New York, US-TX-Dallas, US-AZ-Phoenix, US-IL-Chicago
Organization UCS Sr Mgmt
Schedule Full-time
Number of Openings 2
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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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