Hybrid Quality & Risk Advisor - HEDIS/Risk Expert

Clever Care Health Plan; Huntington Beach (CA); Hybrid; USD 73,000 - 80,000; Full time

Job summary

Clever Care Health Plan in Huntington Beach, CA is seeking a Quality/Risk Advisor to manage relationships with MSOs/IPAs and provider partners while supporting HEDIS/Stars, CAHPS, and risk adjustment KPIs.

This full-time role offers a hybrid schedule with three days onsite at the Huntington Beach office and requires strong data reconciliation, education, and collaborative cross-functional work.

Qualifications

• Bachelor's degree or 4+ years of work related experience in a similar position required.
• 2 years of managed care experience required.
• 2 years of HEDIS/Risk training or education experience preferred.
• Knowledge of HEDIS/Risk regulatory requirements.
• Experience with HEDIS Hybrid Project including.

Responsibilities

• Establish and maintain positive working relationships od MSO/IPA and Providers.
• Quality/Risk Performance Oversight to include meetings, presentation, development of tools, resources and support to ensure MSO/IPAs and providers meet key performance indicators.
• Educate MSO/IPAs and providers on NCQA HEDIS measures and regulatory requirements, risk adjustment, coding best practice, CAHPS.
• Collect, summarize and trend provider data for HEDIS/Risk to develop performance improvement plans.
• Support HEDIS chart collections, abstractions and summary of findings for provider education.
• Participate in external and internal cross-functional workgroups to establish and monitor QI/Risk KPIs, Quality Initiatives, Barrier Analysis and Annual Workplan Reviews and Evaluations.
• Actively participate in Member Experience Initiative including Member Experience Workgroup, Member Advisory Committee and Member Appreciation Events.
• Work closely with Provider Relations and Community Center representatives on Quality/Risk and Member Experience related tasks.
• Partner with Pharmacy team on MSO/IPA and Provider Medication Adherence Performance Initiatives/Strategies.
• May be required to support Member/Provider outreach as needed for Quality/Risk related activities.
• Must be comfortable leading and conducting MSO/IPA and Provider Meetings in-person and/or via team’s meetings.
• Meet with assigned MSO/IPA and Providers at minimum monthly for performance management, oversight and QI strategies. Will need be comfortable creating an agenda, PowerPoint presentation and effectively drive the meeting keeping the provider/IPA engaged and accountable to deliver results. Timely distribution of meeting notes and oversight of action items through completion.

Skills

Effective communication

Leadership by example

Data analysis

HEDIS knowledge

Education

Bachelor's degree or 4+ years related experience

Tools

Microsoft Excel

PowerPoint

Access

Job description

Clever Care Health Plan in Huntington Beach, CA is seeking a Quality/Risk Advisor to manage relationships with MSOs/IPAs and provider partners while supporting HEDIS/Stars, CAHPS, and risk adjustment KPIs.

This full-time role offers a hybrid schedule with three days onsite at the Huntington Beach office and requires strong data reconciliation, education, and collaborative cross-functional work.