a. Provide coordination for the Wellmark HEDIS program including measurement process and ensure adherence to audit standards and technical specifications. Collaborate and coordinate work with the contracted Certified HEDIS Software vendor, and independent HEDIS Auditor in the development and execution of business relationships and improving the HEDIS process.
b. Educate and engage Wellmark internal and external stakeholders on Wellmark’s quality management program (QMP) accreditation, HEDIS and compliance activities. This includes fully informing all appropriate Wellmark staff and appropriate owners of processes of accreditation and compliance requirements, and what specifically is required to stay compliant with said standards. Collaborate on solutions in the process of compliancy.
c. Comply with regulatory standards, accreditation standards and internal policies and remain current with the standards pertinent to the QMP.
d. Coordinate the assigned accreditation/audit functions during onsite surveys.
e. Participate and provide feedback on potential gaps in Wellmark performance and associated risks to accreditation.
f. Identify, recommend and implement quality improvement initiatives that promote the delivery of appropriate identified care, coordinated to preserve member benefit dollars as well as improving member health status, and member satisfaction with Wellmark.
g. Provide critical quantitative and qualitative analysis, identify opportunities for improvement identified and implement with subsequent measurement and analysis of the interventions that equip Wellmark, members and providers to manage the health care of our members, or internal processes or policies.
h. Develop quality improvement reports and dashboards and present to the Quality Committee, other stakeholders and internal business partners.
i. Support the annual HEDIS reporting process.
j. Develop and implement quality improvement work plans, evaluate and report findings to Quality Committee at required intervals.
k. Provide support of the Wellmark Quality Committee. Attend and or provide staff support of assigned committees.
l. Provide support to the Network Administrative leadership team by interacting with Wellmark corporate compliance team to assess impacts from state and federal regulatory requirements, and BCBSA mandates. This includes maintaining the compliance matrix specific to the Quality Management Program, and communicating to leaders when new or existing compliance activities need assessed or completed. This includes supporting the Business Continuity Planning and preparation process.
m. Other duties as assigned.