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Hedis analyst • usa

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HEDIS Quality Improvement Analyst

HEDIS Quality Improvement Analyst

Medical MutualOH, US
[job_card.full_time]
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio.We provide peace of mind to more than 1. We offer fully insured and self-funded group co...[show_more][last_updated.last_updated_variable_days]
HEDIS Analyst

HEDIS Analyst

AmeriHealth CaritasNewtown Square, PA, United States
[job_card.full_time]
The HEDIS Analyst supports corporate, plan-level, and departmental strategies for the HEDIS process by managing the full lifecycle of HEDIS measures, ensuring data accuracy, and interpreting result...[show_more][last_updated.last_updated_variable_days]
HEDIS Stars Analyst

HEDIS Stars Analyst

Well Sense Health PlanValhalla, NY, United States
[job_card.full_time]
Schedule : 7 : 00AM-3 : 00PM Full-Time Monday- Friday .Cross Country Healthcare is looking for top talent to join our team. We are a leader in the healthcare staffing industry with a primary focus on pro...[show_more][last_updated.last_updated_variable_days]
  • [promoted]
HEDIS Program Manager

HEDIS Program Manager

Solis Health PlansMiami, FL, US
[job_card.full_time]
Solis Health Plans is a new kind of Medicare Advantage company.We provide solutions that are transparent, connected, and effective for both our members and providers. Solis was created with a desire...[show_more][last_updated.last_updated_variable_days]
Quality Improvement Analyst HEDIS

Quality Improvement Analyst HEDIS

Centene CorporationPhoenix, AZ, United States
[job_card.full_time] +1
You could be the one who changes everything for our 28 million members.Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll ha...[show_more][last_updated.last_updated_variable_days]
Senior HEDIS Manager

Senior HEDIS Manager

Texas Children's Medical CenterHouston, Mississippi, USA
[job_card.full_time]
Were searching for a Senior HEDIS Manager someone who works well in a fast-paced this position youll be responsible for overseeing maintaining and supporting the departments active programs which ...[show_more][last_updated.last_updated_variable_days]
  • [promoted]
Hedis Quality Manager

Hedis Quality Manager

InnovaCare HealthMidland, TX, US
[job_card.full_time]
The Quality Manager will be responsible for creation and facilitation of training strategies.Programs to support an operational team. Responsible for abstraction of NCQA HEDIS Measures, CAPHS and HO...[show_more][last_updated.last_updated_30]
  • [promoted]
Lead Analyst, Quality Analytics and Performance Improvement (HEDIS)

Lead Analyst, Quality Analytics and Performance Improvement (HEDIS)

Molina HealthcareRio Rancho, NM, United States
[job_card.full_time]
The Lead Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Reporting team.Designs and develops reporting solutions to assist HEDIS Outbound, Inbound extracts...[show_more][last_updated.last_updated_30]
  • [promoted]
HEDIS Network Analyst

HEDIS Network Analyst

Boston StaffingBoston, MA, US
[job_card.full_time]
Provider Engagement & Performance.Position Summary : The HEDIS Network Analyst will support CCA's ability to meet and surpass critical Quality benchmarks and optimize member outcomes as measured thr...[show_more][last_updated.last_updated_30]
  • [promoted]
HEDIS Retriever - Seasonal

HEDIS Retriever - Seasonal

Network Temp IncNew York, NY, US
[job_card.full_time]
The primary function of the HEDIS Retriever - Seasonal is to conduct onsite abstraction of services from medical charts in compliance with HEDIS / QARR, Medicare Advantage Star measure specifications...[show_more][last_updated.last_updated_30]
HEDIS & Stars Analyst

HEDIS & Stars Analyst

WellSense Health PlanRemote, US
[filters.remote]
[job_card.full_time]
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter...[show_more][last_updated.last_updated_variable_days]
HEDIS Data Reviewer

HEDIS Data Reviewer

Pacer GroupPhiladelphia, Pennsylvania, USA
[job_card.full_time]
Position Title : HEDIS Data Reviewer.Location : Philadelphia PA 19113 USA.Under the direction of the Manager of Medical Record Review Operations the HEDIS Data Reviewer is responsible for performing ...[show_more][last_updated.last_updated_variable_days]
  • [promoted]
HEDIS Coordinator

HEDIS Coordinator

FLORIDA DOCTORS GROUP CORPMiami, FL, US
[job_card.full_time]
Florida Doctors Group is a leading MSO committed to improving health outcomes, ensuring compliance, and supporting our providers through hands-on collaboration. Were currently seeking a dedicated.Qu...[show_more][last_updated.last_updated_30]
HEDIS Data Reviewer

HEDIS Data Reviewer

Elevait SolutionsPhiladelphia, Pennsylvania, USA
[job_card.full_time]
HEDIS Data Reviewer Philadelphia PA.The HEDIS Data Reviewer plays a vital role in ensuring the accuracy and compliance of medical record data for HEDIS and State EQRO quality reporting.Reportin...[show_more][last_updated.last_updated_variable_days]
Pennsylvania Licensed HEDIS Coordinator

Pennsylvania Licensed HEDIS Coordinator

VirtualVocationsBuffalo, New York, United States
[job_card.full_time]
HEDIS Coordinator to assist with the management of HEDIS activities and support the Quality Improvement program.Key Responsibilities : Perform day-to-day functions of a HEDIS Coordinator, includin...[show_more][last_updated.last_updated_variable_days]
HEDIS Reviewer

HEDIS Reviewer

ICONMABakersfield, CA, United States
[job_card.full_time]
Our client, a retail pharmacy company, is looking for a HEDIS Reviewer for their remote location.Responsibilities include auditing of information entered into the software system for abstraction an...[show_more][last_updated.last_updated_variable_days]
HEDIS Administrator

HEDIS Administrator

US Tech Solutions, Inc.Canton, MA, US
[job_card.full_time]
Location : Remote Duration : 3 months (with possibility for extension) Overview : We are seeking a HEDIS Coordinator to support a large-scale project involving the collection and tracking of electronic...[show_more][last_updated.last_updated_variable_days]
  • [promoted]
HEDIS Data Reviewer

HEDIS Data Reviewer

US Tech SolutionsPhiladelphia, PA, US
[job_card.temporary]
Location : Philadelphia PA 19113(Hybrid).Duration : 3 months contract with possible extension.Under the direction of the Manager of Medical Record Review Operations, the HEDIS Data Reviewer is respon...[show_more][last_updated.last_updated_30]
  • [promoted]
HEDIS Review Nurse

HEDIS Review Nurse

Spectraforce TechnologiesNorth Chicago, IL, United States
[job_card.full_time]
Remote - City and state must be on resumes.Hours for training and working will be CST.The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effe...[show_more][last_updated.last_updated_variable_days]
HEDIS Quality Improvement Analyst

HEDIS Quality Improvement Analyst

Medical MutualOH, US
[job_card.variable_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Supports corporate and departmental strategies and goals in alignment with regulatory specification for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS). Supports data capture and reporting of clinical quality of care received by members. Works closely with the Quality team to support strategies to improve quality of care received by members, and members' health outcomes.

Note : This is a fully remote opportunity. Eastern Time Zone.

Responsibilities

HEDIS Analyst II

  • Coordinates and collaborates interdepartmentally to produce the annual HEDIS Roadmap. To include data documentation, compilation, reconciliation, and research. Works directly external HEDIS / NCQA auditor to resolve any items on Issue Log.
  • Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
  • Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures. Collaboratively reviews mapping documentation and builds updated requirements for annual HEDIS Specification application and coordinates implementation.
  • Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.
  • Produces routine to moderately complex HEDIS reporting to support clinical Quality initiatives to improve member health.
  • Orients and trains more junior-level Analyst
  • Participates in required trainings and performs other duties as assigned.

HEDIS Analyst III

  • Provides analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and / or providers. Produces in depth, and customized trend reporting across multiple systems and delivers recommendations to improve quality metrics. Collaborates with multiple departments to support performance improvement interventions and initiatives directed to members and / or providers.
  • Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
  • Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures. Collaboratively reviews mapping documentation and builds updated requirements for annual HEDIS Specification application and coordinates implementation.
  • Supports HEDIS submission lifecycle processes such as data compilation, reconciliation, research, and documentation.
  • Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.
  • Orients, trains and assists more junior-level Analysts.
  • Participates in required training and performs other duties as assigned.

    • Sr HEDIS Analyst

  • Leads analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and / or providers. Leads production of in depth, and customized trend reporting across multiple systems and delivers recommendations to improve quality metrics. Collaborates with multiple departments to support performance improvement interventions and initiatives directed to members and / or providers.
  • Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
  • Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures. Leads collaborative review of mapping documentation for annual HEDIS Specification update application and coordinates implementation
  • Orients, assists, trains, mentors, coaches and reviews work of more junior-level Analyst. May supervise staff in absence of Manager
  • Supports HEDIS submission lifecycle processes such as data compilation, reconciliation, research, and documentation
  • Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.
  • Participates in required training and performs other duties as assigned.

    • Lead HEDIS Analyst

  • Schedules, assigns, and monitors projects and prioritizes work based on competing deadlines. Provides peer review, training, and oversight. Tracks work and provides regular progress updates to team and department leadership, and internal and external stakeholders. May provide input in hiring, development, and performance evaluations of more junior analysts.
  • Helps devise and implement clinical quality analytic strategy, priorities, and continuous improvement. Oversees work unit creation of data analyzes and reports. Presents results to inform strategic decision making. Collaborates with internal and external stakeholders to provide appropriate analyses and makes value-added recommendations beyond what is requested.
  • Leads collaboration with team, department leadership, and internal stakeholders to gather, document and execute analytic and reporting requirements in compliance with HEDIS technical specifications, policies, and operating procedures. Explains technical details, relevance, and implications of analytic results to diverse audiences. Incorporates feedback to improve content and format of deliverables. Builds and inspires collaborative relationships within the team and with internal and external stakeholders.
  • Leads in the development and collaborative enhancement of analytic tools and deliverables. Actively participates in department and team meetings. Maintains up to date knowledge and understanding of technical specifications for all HEDIS measures, regulations, and best practices. Serves as a Subject Matter Expert to management and other departments. Leads collaborative review of mapping documentation for annual HEDIS Specification update application and coordinates implementation.
  • Performs other duties as assigned.

    • Qualifications - External

    Qualifications

    HEDIS Analyst II

    Education and Experience :

  • Bachelors Degree in health care administration, public health, or a related field.
  • 2 years experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience.

    • Technical Skills and Knowledge :

  • Knowledge of health insurance industry.
  • Knowledge of project management.
  • Ability to draft analytical assessments and summarize content in simplified language.
  • Ability to execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
  • Intermediate proficiency in database reporting (SQL) and analytics programming languages (SAS).

    • HEDIS Analyst III

    Education and Experience

  • Bachelors Degree in health care administration, public health, or related field.
  • 3 years experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience. programs

    • Technical Skills and Knowledge :

  • Ability to identify opportunities and propose solutions.
  • Ability to develop and produce complex reports and dashboards.
  • Ability to draft analytical assessments and summarize content in simplified language.
  • Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
  • Advanced knowledge of health insurance industry and health plan operations.
  • Ability to utilize certified HEDIS software.
  • Ability to analyze clinical, claims, pharmacy, encounter, and quality measurement data.
  • Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems.
  • Advanced proficiency in database reporting (SQL) and analytics programming languages (SAS) and data visualization tools such as Tableau.

    • Sr HEDIS Analyst

    Education and Experience :

  • Bachelors Degree in health care administration, public health, or related field
  • Master's degree (MBA, MPH, or MHA) preferred
  • 5 years progressive experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience

    • Technical Skills and Knowledge :

  • Ability in identify opportunities and propose solutions.
  • Ability to develop and produce complex reports and dashboards.
  • Ability to draft analytical assessments and summarize content in simplified language.
  • Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
  • Advanced knowledge of health insurance industry and health plan operations.
  • Advanced proficiency in database reporting and data visualization tools including SQL, SAS, and Tableau.
  • Ability to utilize certified HEDIS software.
  • Ability to analyze clinical, claims, pharmacy, encounter, and quality measurement data.
  • Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems.