Hybrid HEDIS Audit Quality Manager

Elevance Health; Port Reading (NJ); Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase & 401k

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee all HEDIS audit activities across lines of business and enterprise scope, ensuring timely submission to NCQA, CMS, and State Regulators. This role requires in-office collaboration 1–2 days weekly and offers hybrid flexibility for commuting candidates.

The position demands extensive HEDIS knowledge, QA/QI experience, and strong project management to lead audit work plans and coordinate state audits with health plans.

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; or any combination of education and experience, which would provide an equivalent background.

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

QA/QI experience

HEDIS knowledge

Education

BA/BS in health care

Job description

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee all HEDIS audit activities across lines of business and enterprise scope, ensuring timely submission to NCQA, CMS, and State Regulators. This role requires in-office collaboration 1–2 days weekly and offers hybrid flexibility for commuting candidates.

The position demands extensive HEDIS knowledge, QA/QI experience, and strong project management to lead audit work plans and coordinate state audits with health plans.