Hybrid HEDIS Audit Quality Lead

Elevance Health; Miami (FL); Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Hybrid work schedule

Comprehensive benefits package

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to lead all HEDIS audit activities across multiple lines of business and regions. The role ensures submission readiness to NCQA, CMS, and state regulators with strong cross-functional collaboration.

Responsibilities include directing audit processes, developing work plans, and ensuring compliance with NCQA, CMA, and state requirements. A BA/BS in healthcare and 3+ years QA/QI experience are required; in-office 1-2 days weekly with hybrid

Qualifications

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

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 ongoing evaluation and interpretation of NCQA, CMA, and state HEDIS requirements to ensure compliance.
• Serves as expert resource to quality committees and business owners across the organization.
• 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 data and reports improvements to the quality committee.
• Coordinates with health plans on state specific audits and reporting requirements.

Skills

HEDIS auditing

QA/QI experience

NCQA guidelines

Project planning

Education

BA/BS in healthcare

Job description

Elevance Health is seeking a HEDIS Audit Quality Manager to lead all HEDIS audit activities across multiple lines of business and regions. The role ensures submission readiness to NCQA, CMS, and state regulators with strong cross-functional collaboration.

Responsibilities include directing audit processes, developing work plans, and ensuring compliance with NCQA, CMA, and state requirements. A BA/BS in healthcare and 3+ years QA/QI experience are required; in-office 1-2 days weekly with hybrid