HEDIS Audit Quality Manager – State, NCQA

Jobtailor; California (MO); On-site; USD 90,000 - 130,000; Full time

Job summary

Jobtailor seeks a seasoned HEDIS Audit Lead to oversee enterprise-wide submissions and manage audit activities across lines of business, regions, and markets. You will interface with internal and external clients, quality committees, and departments to ensure accurate submissions and adherence to guidelines.

Responsibilities include managing audit processes, developing work plans, coordinating resources, and interpreting NCQA/HEDIS requirements while reporting improvements to committees.

Qualifications

• BA/BS in a health care field is required.
• Minimum of 3 years healthcare-related experience.
• Minimum of 3 years in a QA/QI related position.
• Extensive HEDIS audit experience preferred.

Responsibilities

• Manage all HEDIS Audit activities for lines of business, regions, markets, and/or enterprise-wide submissions
• Interface with internal and external clients, quality committees, and departments regarding HEDIS submissions and requirements
• Manage HEDIS audit processes and resources
• Evaluate, interpret, and summarize HEDIS audit guidelines
• Manage HEDIS submission activities
• Identify resources and accountabilities for HEDIS audit project teams
• Evaluate and interpret NCQA, CMA, and State HEDIS requirements
• Serve as an expert resource to quality committees and business owners
• Lead and oversee quality studies and projects
• Facilitate project management and develop HEDIS audit work plans
• Establish deliverables, accountabilities, and timelines
• Perform quantitative and qualitative analysis of quality data
• Report activities, improvements, and recommendations to quality committees
• Coordinate with health plans on state-specific audits and reporting requirements

Skills

HEDIS Audit Management

NCQA Guidelines Knowledge

Quality Assurance/Quality Improvement

Education

BA/BS in health care field

Job description

• Manage all HEDIS Audit activities for lines of business, regions, markets, and/or enterprise-wide submissions
• Interface with internal and external clients, quality committees, and departments regarding HEDIS submissions and requirements
• Manage HEDIS audit processes and resources
• Evaluate, interpret, and summarize HEDIS audit guidelines
• Manage HEDIS submission activities
• Identify resources and accountabilities for HEDIS audit project teams
• Evaluate and interpret NCQA, CMA, and State HEDIS requirements
• Serve as an expert resource to quality committees and business owners
• Lead and oversee quality studies and projects
• Facilitate project management and develop HEDIS audit work plans
• Establish deliverables, accountabilities, and timelines
• Perform quantitative and qualitative analysis of quality data
• Report activities, improvements, and recommendations to quality committees
• Coordinate with health plans on state-specific audits and reporting requirements

Requirements

• BA/BS in a health care field
• Minimum of 3 years healthcare-related experience
• Minimum of 3 years’ experience in a QA/QI related position
• Extensive experience managing overall HEDIS audit processes preferred
• Strong knowledge of NCQA HEDIS audit guidelines and processes preferred
• Experience creating and managing large project plans
• Experience leading mock interviews for external HEDIS audits
• HEDIS audit experience preferred
• Medicaid experience preferred
• Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted

Core Competencies

Demonstrates expertise in managing HEDIS audit activities, including evaluation of NCQA and state requirements, while effectively coordinating with internal and external stakeholders. Proficient in project management, data analysis, and leading quality improvement initiatives within the healthcare sector.

Highest-signal resume keywords

• HEDIS Audit Management
• NCQA Guidelines Knowledge
• Quality Assurance/Quality Improvement Experience