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HEDIS and Performance Improvement Specialist

- Fulltime   HEDIS and Performance Improvement Specialist
Responsible for oversight and plan development of quality improvement initiatives, internal and external education, maintenance of programs for members in accordance with quality standards, conducting data collection, reporting and monitoring of key performance measurement indicators, and implementation of NCQA and Federal/State quality performance and compliance activities.  Occasionally this position may be asked to travel to another community office location to maintain coverage.
Essential Functions
Primary Responsibilities:
  • Implementing identified quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., identifying and removing barriers to care); preparation for quality oversight surveys; and other federal and state required quality activities.
  • Monitoring performance and HEDIS quality activities for timely completion and accuracy.
  • Preparing and presenting executive and detail level summary of quality activities as needed. 
  • Writing narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings of department interventions.
  • Creating, managing and/or compiling the required documentation to maintain critical quality improvement functions.
  • Leading quality improvement activities, meetings and discussions with and between other departments within the organization.
  • Evaluating project/program activities and results to identify gaps and opportunities for improvement.
  • Attending meetings/trainings as needed to stay informed of changes in clinical best practices, local, State, Federal and Division requirements.
  • Other tasks, duties, projects and programs as assigned.
Knowledge, Skills, & Abilities:
  • Experience working with HEDIS software vendors (management, building relationships, issue resolution etc.).
  • High level of diplomacy and discretion is required to effectively negotiate and resolve issues
  • Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
  • Excellent written and oral communication skills.
  • Demonstrate strong business writing skills.
  • Retain large amounts of information and be able to interpret written rules/regulations.
  • Possess organization skills that allow them to balance a wide variety of tasks in a time-effective manner. 
  • Demonstrate proficiency in Visio or flow chart equivalent and Microsoft Office products and be able to quickly learn new software tools.
Education and Work Experience
Education and Experience:
  • Bachelor’s Degree in Social Services, Public Health, or Healthcare Administration or in a related field. May substitute for equivalent experience.
  • 3 years of healthcare experience with 1-year experience in health plan quality improvement, managed care or equivalent experience.
  • 1 year of experience in Medicare and/or Medicaid and HEDIS experience preferred.
  • Project Management experienced preferred.
Valid Driver’s License Required: Yes Travel Type: Domestic Percentage:   0 - 5
Language: Read Write Speak
Licensure and/or Certification
Preferred but not required:
  • Certified Professional in Health Quality (CPHQ)
  • Nursing License (RN)
  • Certified HEDIS Compliance Auditor (CHCA)
Equal Opportunity Employer/ Protected Veteran/ Individuals with Disabilities