Clinical - HEDIS Coordinator - 210403

Mindlance; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A healthcare analytics firm is seeking a professional to ensure HEDIS data accuracy and improve quality metrics. The role requires a Bachelor's degree and relevant experience in quality improvement within the healthcare sector. Responsibilities include coordinating clinical quality metrics and managing HEDIS processes. The ideal candidate will be proactive in identifying improvement opportunities and collaborating with various stakeholders.

Qualifications

• Experience working with HEDIS and NCQA frameworks is a plus.
• Driver's license may be required for certain roles.

Responsibilities

• Coordinate, complete, and update management on clinical quality metrics.
• Establish and maintain an action plan to improve HEDIS scores.
• Implement process to request and evaluate member compliance reports.

Education

Bachelor’s degree in related field or equivalent experience

3+ years of quality improvement or healthcare related experience

Job description

Position Summary

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.”