Join Our Team: Revolutionizing Healthcare Quality through HEDIS Excellence
At the forefront of healthcare quality improvement, our organization is expanding its team to include a seasoned HEDIS Clinical Quality Analyst. This is a unique opportunity to work remotely as a key player in ensuring compliance with the standards set by the National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS). As a HEDIS Clinical Quality Analyst, you will be instrumental in driving clinical direction, guidance, training, and quality oversight for HEDIS-related projects, leveraging your expertise to enhance healthcare outcomes.
About Our Organization and the Role
Our company is dedicated to delivering high-quality healthcare services, with a strong focus on quality improvement initiatives. The HEDIS Clinical Quality Analyst position is pivotal in this mission, requiring a professional with a robust background in clinical quality analysis, particularly in HEDIS measures. This role is designed to be fully remote, offering the flexibility to work from anywhere, although candidates residing in North Carolina are strongly preferred. Occasional travel to our offices in Morrisville or Charlotte, NC, may be necessary.
Key Responsibilities and Duties
- Oversee HEDIS projects, serving as a subject matter expert for NCQA HEDIS measures, including Hybrid, Administrative, and ECDS measures.
- Review and ensure the quality of internal HEDIS processes and plans are aligned with procedures and best practices.
- Participate in the development, research, and implementation of HEDIS improvement activities.
- Plan and implement Primary Source Verification (PSV) and Medical Record Review Validation (MRRV) Audits.
- Oversee the quality of abstraction, quality assurance (QA), and second-level QA for HEDIS Hybrid Projects and Supplemental Data Audits.
- Interpret qualitative and quantitative information to document findings and make recommendations for improvement.
- Identify system and operational issues that could hinder quality performance standards and motivate staff to accomplish tasks successfully.
- Generate monthly/weekly HEDIS Quality reports on measure performance for Directors, Managers, and Supervisors.
- Coordinate and oversee quality management programs and projects to ensure compliance with regulatory bodies.
- Develop and implement quality management and error reduction programs as needed.
- Provide written feedback on quality concerns, compliance risks, and recommended system or process improvements.
- Prepare analyses of initial and repeat HEDIS measures to evaluate the efficacy of interventions.
- Evaluate the validity and accuracy of supplemental data sources.
- Perform data analysis to evaluate gaps in care and prepare comprehensive reports.
- Create HEDIS measure training materials and conduct training/testing for staff.
Minimum Requirements
To be considered for this role, you must have:
- A Registered Nurse (RN) license or Licensed Practical Nurse (LPN) or Compact Nursing License from an accredited school of nursing.
- Five (5) years of healthcare experience in HEDIS clinical quality and process improvement.
- Experience with NCQA Technical Specifications and Value Set Directory.
- Experience with Medical Record Abstraction/Quality Analysis and oversight of HEDIS-related duties.
- Understanding of operational requirements for data collection in support of HEDIS or similar Quality programs.
- Experience working with the Medicaid population related to HEDIS Measures.
Preferred Qualifications
While not mandatory, the following qualifications are highly preferred:
- Experience with data analysis and IT infrastructure related to supplemental data.
- Certified Professional in Healthcare Quality (CPHQ) certification.
Essential Skills and Competencies
To succeed in this role, you must possess:
- Knowledge of North Carolina State and Federal rules related to the service continuum.
- Understanding of Tailored Plan, Integrated Care, and Care Management processes.
- Familiarity with best practices for behavioral & physical health and/or intellectual/developmental disabilities.
- Proficiency in Microsoft Excel, Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tools).
- Strong clinical, problem-solving, interpersonal, analytical, and diplomacy skills.
- Highly effective communication skills with the ability to negotiate and resolve issues.
Career Growth and Learning Opportunities
This role offers a unique opportunity for professional growth and development in a dynamic healthcare environment. As a HEDIS Clinical Quality Analyst, you will be at the forefront of quality improvement initiatives, with the chance to enhance your skills in data analysis, quality management, and leadership.
Work Environment and Culture
Our organization prides itself on a culture that values flexibility, innovation, and teamwork. As a remote worker, you will be part of a distributed team that collaborates closely to achieve common goals. We offer flexible work schedules, including hybrid/remote options, and a comprehensive benefits package that includes medical, dental, vision, life, and long-term disability insurance, along with a generous retirement savings plan.
Compensation and Benefits
The salary range for this position is $75,600 - $98,280 annually, with exact compensation determined based on education, experience, and internal equity. In addition to the competitive salary, our benefits package includes:
- Medical, Dental, Vision, Life, and Long Term Disability insurance.
- A generous retirement savings plan.
- Flexible work schedules, including hybrid/remote options.
- Paid time off for vacation, sick leave, holidays, and management leave.
- Dress flexibility.
Why Apply?
If you are a motivated professional with a passion for healthcare quality improvement, we encourage you to apply for this exciting opportunity. As a HEDIS Clinical Quality Analyst, you will play a critical role in driving clinical excellence and ensuring compliance with regulatory standards. Don't hesitate to apply, even if you don't meet every single requirement. We value a great attitude and a willingness to learn above all.
Join our team today and be part of revolutionizing healthcare quality through HEDIS excellence!
Apply Now