HEDIS Coordinator - 210403

Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes. Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality.

Description: Job Profile Summary
Position Purpose:
Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas.

Education/Experience:
Bachelor s degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred.

For the Nevada Silver Summit Health Plan only: Driver's license required.

For Health Net Federal Services only: Government Security/Clearance/US Citizenship Requirements

Responsibilities
Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results

Establish and maintain an action plan to improve HEDIS scores

Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities

Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes

Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality

Conduct quality audit and maintain all data and process controls to ensure compliance
Performs other duties as assigned

Complies with all policies and standards

Custom Fields:
Name: If this request is replacing a previously canceled request, please provide the original Request ID
Value: None

Name: Which Health Plan, programs or functions will this work support?
Value: Coordinated Care

Name: Field Worker
Value: No

Name: Shortlisting Date
Value: None