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Director, Quality Analytics & Risk Adjustment

Working Each Day to Make a Difference

At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visit

Director, Quality Analytics & Risk Adjustment

Drive corporate success in achieving outstanding quality of care for our members by providing sharp and timely analytics and insight. Innovate on quality measurement data sourcing and opportunity identification. Execute on a broad array of risk adjustment programs. Synthesize our HEDIS and risk adjustment activities into a coordinated, year-round program. Lead a team of highly skilled professionals, collaborate across departments, and stay current on emerging ideas and technology related to quality performance measurement and risk adjustment.

• Work closely with Sr Director, Population Analytics to develop vision and strategy to improve the acquisition, collection, reporting and audit of data related to HEDIS and Risk Adjustment.
• Collaborate with senior leaders across the company to identify and execute key analytics projects to improve organizational performance on quality and risk adjustment related measures.
• Serve as primary point of contact with state and federal agencies.
• Manage team responsible for capturing, analyzing, and reporting HEDIS and risk adjustment data for Medicare and Medicaid.
• Collaborate with internal and external stakeholders to ensure HEDIS, CAHPS/HOS and risk adjustment initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members.
• Direct HEDIS submission and audit process amongst direct reports, internal departments and external vendors. This includes completion of roadmap, management of pre-audit, onsite and post audit process, and of NCQA auditor relationships.
• Work with direct reports and IS&T team to ensure accuracy of data and systems to produce unbiased HEDIS results, including data validation and researching variances among HEDIS measures.
• Direct risk-adjustment related programs to ensure accuracy and effect.
• Ensure compliance with CMS guidelines related to coding and data submission.
• Demonstrate leadership and vision through proactive identification of new risk adjustment and quality measurement opportunities.
• Stay current on industry trends and implement programmatic and reporting innovations.
• Build a cohesive, motivated team through clear direction, high expectation and delegation of responsibility and accountability. Mentor staff in analytic approaches, time management, and presentation of results. Determine future recruitment needs.
• Set and manage department budget.
• Manage vendor contracts and provide vendor oversight.
• Exempt – Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.


• Bachelor’s degree in Healthcare Administration, Business Administration or a quantitative disciple such as Mathematics, Statistics or Economics, or an equivalent combination of education and highly relevant experience required.

Prior Related Experience:
• Minimum seven (7) years of health plan experience, preferably with focus in healthcare analytics, risk adjustment, and/or HEDIS quality performance measurement.
• Minimum four (4) years of experience leading and managing staff.
• Experience with advanced analytic features of SQL, Access and Excel.

Employment Eligibility:
• Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Knowledge, Skills, and Abilities:
• Demonstrated independent and complex problem-solving skills; including the ability to assist others in working through complex problems to meet desired outcomes.
• Ability to effectively manage and drive performance, and delegate and hold individuals and team accountable for goal achievement and overall performance.
• Knowledge of HEDIS, CAHPS, HOS, STARS and risk adjustment requirements and their impact on the organization.
• Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.
• Demonstrated ability to add insight and value to corporate initiatives, including program evaluation and innovation.
• Effective verbal and written communication skills
• Flexibility and willingness to work in a matrix-management environment
• Demonstrated organizational, time management, and project management skills
• Ability to multi-task and deal with complex assignments on a frequent basis
• Demonstrated proficiency and experience with Microsoft Office products
• Collaborate with others in a respectful manner
• Ability to hire, motivate and mentor team members, and plan and prioritize their work.
• Able to work under pressure and time constraints. Ability to handle multiple priorities and meet scheduled deadlines.
• Proficiency in Microsoft Office programs.
• Ability to travel as necessary.
• Ability to maintain a professional demeanor and confidentiality.

To apply, please visit:
We're committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.

Community Health Plan of Washington is an Equal Opportunity Employer with a diverse workforce!

Headquarters: 1111 3rd Avenue, Suite 400 Seattle, WA 98101

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 2/5/2020 1:15:11 PM

Job Contact:
Jordan Smith
(800) 440-1561

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1111 Third Avenue
Seattle, WA 98101

(800) 440-1561