Hybrid HEDIS Audit Quality Manager

Elevance Health; Mendota Heights (MN); Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Hybrid work arrangement

Benefits package

401(k) plan

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee HEDIS audits across lines of business, regions, and enterprise needs. The role ensures compliance with NCQA, CMS, and state regulators, and leads audit planning, resource coordination, and reporting.

Responsibilities include interfacing with clients and quality committees, managing audit processes, developing work plans, and delivering data-driven improvements to the quality program while supporting hybrid in-office and remote

Qualifications

• Requires a BA/BS in a health care field and minimum of 3 years healthcare-related experience, in addition, minimum of 3 years’ experience in a QA/QI related 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 the ongoing evaluation and interpretation of NCQA, CMA, and State HEDIS requirements to ensure compliance through reporting and measurement studies/ methodologies.
• 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 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 audits

Quality management

Stakeholder coordination

Education

BA/BS in health care field

Job description

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee HEDIS audits across lines of business, regions, and enterprise needs. The role ensures compliance with NCQA, CMS, and state regulators, and leads audit planning, resource coordination, and reporting.

Responsibilities include interfacing with clients and quality committees, managing audit processes, developing work plans, and delivering data-driven improvements to the quality program while supporting hybrid in-office and remote