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
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
============
| Story Behind the Need Business Group & Key Projects |
- Health plan or business unit
- Team culture
- Surrounding team & key projects
- Purpose of this team
- Reason for the request
- Motivators for this need
- Any additional upcoming hiring needs?
| Need for full time support for HEDIS hybrid season
Working with a team of 10-15 for multi-state HEDIS hybrid medical record requests |
| Typical Day in the Role |
- Daily schedule & OT expectations
- Typical task breakdown and rhythm
- Interaction level with team
- Work environment description
| See above information provided for schedule and OT breakdown
Duties include: - Monitor/manage incoming medical records; including downloading, splitting and renaming of incoming records via fax or email.
- Investigate and contact providers to confirm demographic information and request medical records.
- Escalation of chart retrieval efforts as needed to ensure record retrieval.
- Management of pended unable to contact records.
- Review claims database for evidence of date of service.
- Potential for rate max of medical records for compliance with HEDIS standards (depending on experience).
|
| Compelling Story & Candidate Value Proposition |
- What makes this role interesting?
- Points about team culture
- Competitive market comparison
- Unique selling points
- Value added or experience gained
| |
| Candidate Requirements |
| Education/Certification | High School Diploma | Preferred: |
| Licensure | N/A | Preferred: |
- Years of experience required
- Disqualifiers
- Best vs. average
- Performance indicators
| Must haves: - Medical Record Experience
- Health care or MCO experience
- Strong computer program and navigational skills (excel, outlook, adobe pdf, etc)
Nice to haves: - Claims Experience
- Datavant portal experience
- Provider outreach call experience
- HEDIS or NCQA knowledge
Disqualifiers:
Performance indicators: - Required to onboarding medical record management test including downloading, splitting and renaming files to show evidence of understanding of project steps prior to project start.
|
- Top 3 must-have hard skills
- Level of experience with each
- Stack-ranked by importance
- Candidate Review & Selection
| 1 | See above must haves |
| 2 | |
| 3 | |
| Candidate Review & Selection |
- Shortlisting process
- Second touchpoint for feedback
- Interview Information
- Onboard Process and Expectations
| Projected HM Candidate Review Date: | 11/23/2026 |
| Number and Type of Interviews: | 1 Panel Interview 30 minutes |
| Extra Interview Prep for Candidate: | N/A |
| Required Testing or Assessment (by Vendor): | Microsoft testing if possible |
| Manager Communication Preferences & Next Steps |
- Background Check Requirements (List DFPS or other specialty checks here)
| No |
- Do you have any upcoming PTO?
| Unable to interview 11/25, 11/30-12/4
Extending offers by 12/11 |