Strategic HEDIS Audit Quality Lead | Hybrid

Elevance Health; Woburn (MA); Hybrid; USD 99,000 - 163,000; Full time

Benefits offered by this job

Benefits package

Incentive programs

Stock Purchase Plan

401(k) contribution

Job summary

Elevance Health is seeking a HEDIS Audit Quality Manager to oversee all HEDIS audit activities across lines of business, regions, and enterprise. You will manage the audit processes, interpret NCQA guidelines, and coordinate with internal teams and health plans to ensure compliant submissions.

The role requires a BA/BS in a health care field and at least 3 years of healthcare QA/QI experience, with strong project management and cross-functional collaboration skills.

Qualifications

• Requires BA/BS in a health care field and at least 3 years healthcare QA/QI experience.
• Candidates with HEDIS audit experience and NCQA knowledge are preferred.
• Strong project management skills and ability to coordinate across teams are essential.

Responsibilities

• Interfaces with internal/external clients and quality committees to review HEDIS submissions.
• Oversees HEDIS audit processes and resources for the team.
• Interprets NCQA, CMA, and State HEDIS requirements to ensure compliant submissions.
• Develops HEDIS audit work plans with deliverables and timelines.
• Analyzes quality data and reports improvements to the quality committee.
• Coordinates with health plans on state-specific audits and reporting requirements.

Skills

HEDIS audits

QA/QI experience

Project management

NCQA guidelines

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, regions, and enterprise. You will manage the audit processes, interpret NCQA guidelines, and coordinate with internal teams and health plans to ensure compliant submissions.

The role requires a BA/BS in a health care field and at least 3 years of healthcare QA/QI experience, with strong project management and cross-functional collaboration skills.