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.
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| Story Behind the Need |
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
| - 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.
- Medical records requests, member outreach for target quality measures, provider communication campaigns for target measures and target actions
- Preferred experience with quality measures, HEDIS, provider office, or other clinical settings as foundational experience
- LPN, RN, other clinical or adjacent certification or license preferred, but not required
|
| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| See above |
| Candidate Requirements |
| Education/Certification | Required: | Preferred: LPN, RN, other clinical or adjacent certification or license preferred, but not required |
| Licensure | Required: | Preferred: LPN, RN, other clinical or adjacent certification or license preferred, but not required |
Years of experience required: 3+ years of quality improvement or healthcare related experience
Disqualifiers:
Additional qualities to look for: |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | HEDIS or quality improvement related experience |
| 2 | Medical records or provider office/clinical setting experience |
| 3 | Patient care experience |
| Candidate Review & Selection |
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
| Projected Manager Candidate Review Date: | 24-48 hours after shortlisting |
Type of Interviews: Teams
| Teams |
| Required Testing or Assessment (by Vendor): | |
| Next Steps |
- Do you have any upcoming PTO?
| TBD |
- Colleagues to cc/delegate
| Melissa Cornejo, Apexya Patel |