Quality & Risk Advisor - Managed Care & HEDIS Excellence

Paycom; 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 HEDIS/Stars, risk adjustment and QA activities with MSOs, IPAs and provider partners.

The role requires a Bachelor’s degree or 4+ years of managed care experience, 2 years of HEDIS/Risk training, and strong data analysis skills. This is a hybrid position with 3 days onsite at the Huntington Beach office.

Qualifications

• Bachelor's degree or 4+ years of work experience in a similar role.
• 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 data reconciliation and root cause analysis.

Responsibilities

• Establish and maintain relationships with MSO/IPA and Providers.
• Oversee HEDIS/Risk performance and prepare improvement plans.
• Educate providers on NCQA HEDIS measures and regulatory requirements.
• Collect and trend provider data for HEDIS/Risk and develop action plans.
• Support chart collections, abstractions and provider education.
• Lead cross-functional workgroups to monitor KPIs and Quality Initiatives.
• Participate in Member Experience initiatives and provider outreach as needed.
• Lead MSO/IPA and Provider meetings with agendas and action-item tracking.

Skills

Effective communication

Relationship management

Data reconciliation

HEDIS knowledge

Risk adjustment

Education

Bachelor's degree or 4+ years experience

Tools

Excel

PowerPoint

Access

Job description

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

The role requires a Bachelor’s degree or 4+ years of managed care experience, 2 years of HEDIS/Risk training, and strong data analysis skills. This is a hybrid position with 3 days onsite at the Huntington Beach office.