Supervise and coordinate team to ensure HEDIS data accuracy and reporting, including investigations, auditing, and improvement opportunities.
Collaborate with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members.
Coordinate activities, resources, methods, and procedures to achieve improvement in HEDIS measures with the business leaders and cross functional departments
Coordinate with the department leader to formulate and ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines
Supervise the daily activities of staff to promote quality improvement and efficient methods
Assist with comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures
Coordinate clinical quality metrics and HEDIS processes and results
Coordinate cross functional process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
Manager the coordinate HEDIS projects to include assignment of nurses, adherence to plan timelines, and vendor oversight for timeliness and quality
Ensure compliance for all quality audits and maintain all data and process controls
HEDIS Supervisor Background:
Bachelor’s Degree in nursing, health care management, public health, or related discipline is required; Master’s degree is a plus.
Requires at least 3 years of quality improvement, HEDIS project management or health care related experience.
Requires working knowledge of NCQA and HEDIS programs.
Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
Ability to determine HEDIS compliance, with knowledge of key drivers for HEDIS, HOS and STAR measures.
Strong analytical mind, with problem solving and investigative skills, an aptitude for accuracy, and attention to detail; essential to evaluate data for accuracy and integrity.
Must be computer literate and knowledgeable in MS Office and program management software.
Possess superior verbal and written communication skills, able to interface with business and medical professionals.