Job Profile Summary
Position Purpose:
Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas.
Education/Experience:
Bachelor’s degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred.
For the Nevada Silver Summit Health Plan only: Driver's license required.
For Health Net Federal Services only: Government Security/Clearance/US Citizenship Requirements
Responsibilities
Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results
Establish and maintain an action plan to improve HEDIS scores
Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes
Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
Conduct quality audit and maintain all data and process controls to ensure compliance
Performs other duties as assigned
Complies with all policies and standards
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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Job Profile Summary
Position Purpose:
Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas.
Education/Experience:
Bachelor’s degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred.
For the Nevada Silver Summit Health Plan only: Driver's license required.
For Health Net Federal Services only: Government Security/Clearance/US Citizenship Requirements
Responsibilities
Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results
Establish and maintain an action plan to improve HEDIS scores
Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes
Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
Conduct quality audit and maintain all data and process controls to ensure compliance
Performs other duties as assigned
Complies with all policies and standards
Story Behind the Need
We are needing assistance in Q4 to bring in more records to close HEDIS care gaps and review submitted records. We have a strong team that is very knowledgeable in HEDIS, but are needing extra assistance to pull and process records for Medicaid and Marketplace populations.
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
Will work member gap lists to search EMR’s and pull qualifying records as well as audit submitted records for validation. Goal is 80 – 100 charts per day for review. Must be very familiar with HEDIS measures and technical specifications. Will need to pass measure tests with 95% or higher to work on measures. The leadership team will administer this test after they start.
Candidate Requirements
Required: 3+ years in Quality Improvement/HEDIS
Preferred: Bachelor’s Degree
Required: NA
Preferred:
Years of experience required: Bachelor’s degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred.
Disqualifiers: No knowledge or work history with HEDIS
Additional qualities to look for: Strong HEDIS measure experience, EMR experience
- Top 3 must-have hard skills stack-ranked by importance
1
HEDIS and EMR experience
2
Microsoft Application experience, Excel
3
Team collaborator and driven focus on task
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Teams or Zoom- Cameras On
Required Testing or Assessment (by Vendor):
Next Steps
- Do you have any upcoming PTO?
No
