HEDIS Audit Quality Lead

Elevance Health; Florida; Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Equity stock purchase

401k contribution

Incentive programs

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee HEDIS audit activities across lines of business and regions, ensuring timely submission to NCQA, CMS, and state regulators. The role combines in-office collaboration 1–2 days per week with flexibility for remote work.

You will manage audit processes, coordinate resources, interpret guidelines, lead quality studies, and partner with health plans to meet state-specific requirements.

Qualifications

• Requires BA/BS in a health care field and 3 years healthcare-related experience, plus 3 years’ experience in QA/QI.

Responsibilities

• Interfaces with internal and external clients, quality committees, and departments in the review of HEDIS submissions and requirements.
• Manages the overall HEDIS audit processes and resources required to successfully lead the team.
• Evaluates, interprets and summarizes HEDIS audit guidelines and manages the process for HEDIS submission activities.
• Identifies appropriate resources and accountabilities for project teams involved with the HEDIS audit.
• conducts the ongoing evaluation and interpretation of NCQA, CMA, and State HEDIS requirements to ensure compliance.
• Leads and provides oversight of quality studies/projects.
• Facilitates project management and develops comprehensive HEDIS audit work plans by establishing deliverables, accountabilities, and timelines.
• Performs quantitative and qualitative analysis of quality related data and reports activities, improvements, and recommendations to the quality committee.
• Coordinates with health plans on state specific audits and reporting requirements.

Skills

HEDIS Audit

QA/QI

Project Management

Data Analysis

Stakeholder Liaison

Education

BA/BS in health care

Job description

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee HEDIS audit activities across lines of business and regions, ensuring timely submission to NCQA, CMS, and state regulators. The role combines in-office collaboration 1–2 days per week with flexibility for remote work.

You will manage audit processes, coordinate resources, interpret guidelines, lead quality studies, and partner with health plans to meet state-specific requirements.