Remote HEDIS Quality Analyst & Improvement Lead

Alliance Health; North Carolina; On-site; USD 85,000 - 110,000; Full time

Job summary

Alliance Health seeks a HEDIS Clinical Quality Analyst to provide clinical direction, guidance, training, and quality oversight for HEDIS measures. You will oversee data collection, medical record review, and quality improvement activities in both prospective and retrospective seasons to ensure NCQA and CMS standards are met.

The role supports remote work with periodic in-office meetings as needed, and involves mentoring staff and coordinating audits to improve care quality for Medicaid

Qualifications

• RN or LPN with five years of healthcare experience in HEDIS
• Experience with NCQA Technical Specifications and Value Set Directory
• Experience with Medical Record Abstraction and Quality Analysis for HEDIS
• Knowledge of NCQA Health Plan HEDIS data collection and reporting requirements
• Understanding operational requirements for data collection in support of HEDIS
• Experience with Medicaid population related to HEDIS measures
• CPHQ certification preferred

Responsibilities

• Oversee NCQA HEDIS measures and related projects (hybrid, administrative and ECDS)
• Review internal processes and QA for HEDIS alignment with procedures and best practices
• Participate in development, research, and implementation of HEDIS improvements
• Plan PSV and MRV audits
• Ensure accuracy of abstraction and QA for Hybrid and SDVA audits
• Provide guidance and training to project teams on NCQA HEDIS
• Identify issues affecting quality performance and recommend improvements
• Monitor performance metrics and report findings to leadership
• Coordinate data analysis and quality interventions and report results
• Train staff on HEDIS measure training manuals and NCQA specifications

Skills

HEDIS knowledge

Quality improvement

Data analysis

Training guidance

Communication skills

Education

RN license

LPN license

Tools

Excel

SPSS

SurveyMonkey

Job description

Alliance Health seeks a HEDIS Clinical Quality Analyst to provide clinical direction, guidance, training, and quality oversight for HEDIS measures. You will oversee data collection, medical record review, and quality improvement activities in both prospective and retrospective seasons to ensure NCQA and CMS standards are met.

The role supports remote work with periodic in-office meetings as needed, and involves mentoring staff and coordinating audits to improve care quality for Medicaid