HEDIS Specialist

Centene Management Company LLC; Missouri; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Management Company LLC seeks a Behavioral Health HEDIS Improvement Supervisor to supervise interventions that drive HEDIS and Pay-for-Performance outcomes. You will partner with health plans and regional clinical leadership to identify and implement strategies that raise behavioral health metrics.

You will coordinate with quality improvement teams, present ROI analyses, monitor initiatives, and guide clinical staff to sustain improvements. A flexible work approach is supported.

Qualifications

• Bachelor’s degree in nursing, related field, or equivalent experience.
• 3+ years of experience in case and/or utilization management in behavioral/physical health care.
• Knowledge of HEDIS & performance measures with experience implementing interventions.

Responsibilities

• Develop and implement strategies with clinical staff to improve HEDIS/P4P measures.
• Prepare and present ROI for initiatives requiring funding.
• Liaise with QA, health plans and departments; collect input and report outcomes.
• Monitor P4P/HEDIS initiatives and ensure education and interventions reach members.
• Analyze data to identify trends and opportunities for quality improvement.
• Performs other duties as assigned.
• Complies with policies and standards.

Skills

Supervisory experience

HEDIS knowledge

Data analysis

Education

Bachelor’s degree in nursing or related field

Job description

Position Purpose

Supervise and facilitate successful interventions to meet behavioral health HEDIS and Pay for Performance measures. Partner with health plans and regional clinical leadership to identify and implement interventions to increase HEDIS rates in behavioral health measures.

Responsibilities

• Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures
• Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources
• Act as a liasion with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes
• Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures
• Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders
• Performs other duties as assigned
• Complies with all policies and standards

Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
• Knowledge of key behavioral or physical health related HEDIS & performance measures required with preferred experience in implementing new interventions to affect these rates. Supervisory or lead experience preferred.
• Education/Experience: Bachelor’s degree in nursing, related field, or equivalent experience. 3+ years of experience in case and/or utilization management in a behavioral health or physical health care setting.
• License/Certificates: Current state’s unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN preferred.

Pay

Pay Range: $56,200.00 - $101,000.00 per year

Benefits

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

About Centene

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Should you need an accommodation, please email [e-mail].

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.