Owns overall HEDIS and CMS Core Measures clinical strategy and reporting intent across product lines
Interprets NCQA HEDIS specifications, CMS Core Measures specifications, FAQs, and technical guidance
Determines measure inclusion/exclusion, hybrid vs. administrative approach, and reporting decisions
Provides clinical judgment and escalation support for complex or ambiguous scenarios
Monitors NCQA HEDIS updates, CMS Core Measures updates, technical bulletins, FAQs, and measure changes
Assesses the impact of upcoming HEDIS and CMS Core Measure changes on organization programs, data sources, and workflows
Partners with IS (Information Systems) to identify and ensure changes are made outside of production season
Partners with the MRR Manager on MRR strategy, reconciliation, and quality oversight
Owns clinical QA/UAT for new or modified measures and other related data sources
Owns business and clinical content of the HEDIS and CMS Core Measures Roadmap
Works closely with IS, Product Line Managers, Population Health/QI, MRR, and vendors

Bachelor's degree in healthcare, public health, nursing, health administration, or related field required
4-6 years of experience in HEDIS, quality measurement, NCQA, or healthcare quality analytics required
1-3 years clinical background (RN) or equivalent clinical informatics experience required
3-5 years previous management experience required
Demonstrated experience interpreting HEDIS measures and NCQA requirements
Experience supporting or participating in HEDIS audits
Strong written and verbal communication skills, including audit-facing communication.

Outstanding benefits including up to 27 paid days off per year
Immediate retirement plan employer contribution up to 9.5%
Generous medical plans
Free RTD EcoPass (public transportation)
On-site employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Senior Manager, HEDIS – Business/Clinical Lead

Key skills