HEDIS Coordinator

Location: Sunflower Health Plan

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 evidence, documentation, 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.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements:

• Bachelor’s degree in a related field or equivalent experience.
• Minimum 3 years of quality improvement or healthcare-related experience.
• Working knowledge of the National Committee on Quality Assurance (NCQA).
• Driver's license required for the Nevada Silver Summit Health Plan only.
• Government Security/Clearance/US Citizenship requirements for Health Net Federal Services only.

Preferred Skills:

• HEDIS requirements preferred.