• Develop and implement Triple S’ initiatives and work plan in order to comply with CMS, ASES, BCBS, and OPM Federal requirements related to the collection and reporting of the applicable HEDIS measures for each line of business.• Evaluate information to determine and monitor compliance with standards established by the regulatory agencies, such as the Centers for Medicare and Medicaid Services (CMS), Puerto Rico Health Insurance Administration (ASES for its Spanish Acronym), Office of Commissioner of Insurer (OCI), National Committee for Quality Assurance (NCQA), Office of Personnel Management (OPM), among others.• Develop and present to the senior management a full report with findings, recommendations and if applicable any corrective action plans implemented as a result of HEDIS for all lines of business.• Oversee completion, collection and review of HEDIS Roadmap and project’s requirements.• Monitor data collection for HEDIS measures.• Responsible for communicating performance results of HEDIS for all lines of business and improvements to stakeholders and leadership, including Triple S Board of Directors (BOD).• Establish processes and strategies to perform HEDIS medical reviews, CDI projects, physicians’ quality audits and special projects reviews.• Participate actively in the process of compiling data, record review and results analysis of HEDIS audits, intervention plans, CAHPS, HOS and other projects assignment by Management.• Identify, analyze and report to Management patterns in HEDIS Results (on and off season).• Responsible for identifying opportunities to implement innovative initiatives to enhance the results for HEDIS.• Actively participate in the contracting process of vendors needed to support HEDIS operation.• Participate in the definition of requirements for initiatives, and the evaluation of and negotiation with vendors that may provide services to support HEDIS, CAHPS and HOS initiatives.• Manage the implementation of initiatives with vendors contracted to support HEDIS including coordination of meetings, written communications, report definitions, performance guarantees, active monitoring, and measuring return of investment.• Oversee contracted vendors, including but not limited to, recurrent meetings, quality checks/over reads, among others.• Develop and present to senior management a full report with findings, recommendations and if applicable any corrective action plans implemented as a result of HEDIS initiatives implementation.• Communicate on a timely manner the identified non-compliance issues to the Management, Compliance, etc. as necessary.• Serve as subject matter expert (SME) in any ASES, BCBS, OPM, NCQA, and CMS and/or other regulatory agency and/or Compliance audit and/or monitoring effort.• Develop executive level presentations to communicate results and offer recommendations.• Promote policies and procedures following recognized standards of care, accreditation, compliance standards and guidelines, and other evaluating entities, including state and federal agencies.• Establish educational and training strategies with providers and Organizational Areas to achieve Quality goals.• Participate as a resource in the necessary trainings for primary physicians and participating providers.• Develop or review the quality indicators in the light of new trends in medicine, regulatory agencies and accrediting and changes in the health industry.• Active participation in the applicable quality committees to provide feedback on results related to HEDIS, CAHPS and/or HOS initiatives.• Set standards for measuring continuous staff performance, identify areas for improvement and develop and implement training activities.• Develop and implement quality initiatives that will improve the indicators required by different customers and contracts.• Provides counseling to vendors and operational areas.• Provide support to the Revenue Department in the medical record review process for RADV audits.• Assists and collaborates in strategies to achieve goals for CMS Quality and Star Rating.• Contribute and cooperate in any business matter related to the Quality and Stars Department.• Participates in proactive team efforts to achieve departmental and company goals.• Develop and promote cross training within the Department.• Responsible for preparing programs, assigning tasks, supervising workflow, reviewing expenses, and monitoring employees’ daily performances and activities.• Responsible for interviewing, selecting, training employees.• Complete performance reports and takes disciplinary actions when necessary• Other tasks as assigned by the Management and which are essential to the position.Bachelor’s Degree in Business Administration or Nursing with five (5) to seven (7) years of experience in the implementation of quality programs, health services administration, and/or HEDIS Audit.