Senior Manager of HEDIS, Business/Clinical Lead - ...

We are recruiting for a mission-driven Senior Manager of HEDIS, Business/Clinical Lead - Denver Health Medical Plan (* Hybrid Work Schedule *) to join our team!We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey. Our ValuesRespect | Belonging | Accountability | TransparencyDepartmentManaged Care Administration*Hybrid Work ScheduleJob SummaryThe Senior Manager, who will also function as a HEDIS Project Lead, is the accountable business and clinical owner of the HEDIS and Core Measure program across all product lines. This role is responsible for clinical interpretation of measures, reporting strategy, audit readiness, and cross-functional coordination to ensure HEDIS and Core Measure results are accurate, compliant, and defensible.This role serves as the primary authority for what is reported and why, partnering closely with the HEDIS/Core Measure Technical Lead, MRR leadership, and business stakeholders. The role operates on a year-round cadence, supporting design, validation, production, audit, and submission activities.Essential Functions: HEDIS Program & Clinical Leadership• 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• Assess 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:• New or modified measures• Required data sources or automations• Requirements or simplifications of existing logic(25%)Medical Record Review (MRR) Oversight• Partners with the MRR Manager on MRR strategy, reconciliation, and quality oversight(10%)QA / UAT (Clinical)• Owns clinical QA/UAT for:• New or modified measures• HEDIS and Core Measures main software (Cotiviti) data and refreshes plus other Supplemental Data Sources (SDS)• CAHPS samples and outputs• Confirms outputs align with clinical intent prior to audit and submission(25%)Audit & Roadmap Ownership• Owns business and clinical content of the HEDIS and CMS Core Measures Roadmap• Leads clinical responses to audit questions and issue logs• Serves as a primary clinical point of contact for external auditors(25%)Cross-Functional Leadership• Works closely with IS, Product Line Managers (PLMs), Population Health/QI, MRR, and vendors• Ensure business stakeholders are engaged early and consistently• Supports governance and decision-making across the HEDIS and CMS Core Measure lifecycle(15%)Education: Bachelor's degree in healthcare, public health, nursing, health administration, or related field requiredWork Experience: 4-6 years of experience in HEDIS, quality measurement, NCQA, or healthcare quality analytics required AND1-3 years clinical background (RN) or equivalent clinical informatics experience required AND3-5 years previous management experience requiredLicenses:Knowledge, Skills and Abilities: Demonstrated experience interpreting HEDIS measures and NCQA requirementsExperience supporting or participating in HEDIS auditsStrong written and verbal communication skills, including audit-facing communicationPreferred Qualifications• 7+ years of progressive HEDIS or quality program leadership experience• Demonstrated experience interpreting CMS Core Measures and CMS reporting requirements• Experience serving as a primary clinical lead or decision-maker during an audit• Familiarity with HEDIS vendor platforms (e.g., Cotiviti)• Experience supporting CAHPS processes and submissionsShiftDays (United States of America)Work TypeRegularSalary$108,500.00 - $173,700.00 / yrBenefitsAt Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you. Here is a small list of our benefit programs: Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays100% paid parental leave up to 6 weeksImmediate eligibility for retirement plans with employer contribution up to 9.5%Generous medical, dental, vision plans in addition to employer paid disability and life insurance.Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE CenterFree RTD EcoPass (public transportation)Childcare discount programs & exclusive perks on large brands, travel, and moreTuition reimbursement & assistanceEducation, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathwaysProfessional clinical advancement program & shared governancePublic Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF programNational Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employerAbout Denver HealthDenver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation. As Colorado's primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.

Created: 2026-04-15