Denver Health

Senior Manager, HEDIS – Business/Clinical Lead

Denver Health

full-time

Posted on:

Location Type: Hybrid

Location: Denver • Colorado • United States

Visit company website

Explore more

✨ AI Apply
Apply

Salary

💰 $108,500 - $173,700 per year

Job Level

Senior

About the role

  • 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

Requirements

  • 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.
Benefits
  • 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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
HEDISCMS Core MeasuresNCQAquality measurementclinical judgmentclinical QAUAThealthcare quality analyticsclinical informaticsdata analysis
Soft Skills
communicationleadershipcollaborationproblem-solvingorganizational skillsanalytical skillsattention to detailescalation supportstrategic thinkingquality oversight
Certifications
Bachelor's degree in healthcareBachelor's degree in public healthBachelor's degree in nursingBachelor's degree in health administrationRN license