HEDIS Performance Improvement Specialist
About The Position
This role is responsible for planning, designing, implementing, and maintaining a comprehensive program of continuous quality improvement (CQI). The specialist will assist in educating new staff and providers about quality improvement (QI) systems and requirements, leveraging knowledge of quality improvement principles, practices, and procedures. The position oversees complex HEDIS project lifecycles, including data analysis, medical record abstraction, chase logic, and thorough knowledge of Performance Improvement Projects (PIPs). The specialist will apply this knowledge in PIP writing development, updates, and data analysis. A key aspect of the role involves analyzing HEDIS data to develop interventions for gaps in care. The specialist will also maintain a deep working knowledge of URAC/NCQA standards, the Uniform Managed Care Contract, and state-specific programs like Texas Health Steps and Alternative Payment Models.
Requirements
- High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required.
- Bachelor's Degree in Nursing is a must-have.
- 2+ years of Registered Nurse (RN) experience.
- 2+ years of HEDIS experience.
- Experience with Performance Improvement Projects (PIP).
- Must reside in Texas.
Nice To Haves
- Certification specializing in Lean Healthcare Mgmt preferred.
- Project Management Professional preferred.
- Registered Nurse preferred.
Responsibilities
- Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI).
- Assist in educating new staff and providers about quality improvement (QI) systems and requirements.
- Oversee complex HEDIS project lifecycles, including data analysis, medical record abstraction, and chase logic.
- Apply knowledge of Performance Improvement Projects (PIPs) in PIP writing development, updates, and analysis of data in PIPs.
- Analyze HEDIS data to develop interventions for gaps in care.
- Maintain deep working knowledge of URAC/NCQA standards, the Uniform Managed Care Contract, and state-specific programs like Texas Health Steps and Alternative Payment Models.
Benefits
- Eligible for an annual bonus incentive
- Paid time off (PTO)
- Various health insurance options & wellness plans
- Retirement benefits including employer match plans
- Long-term & short-term disability
- Employee assistance programs (EAP)
- Parental leave & adoption assistance
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
