HEDIS Specialist
Centene Corporation•Remote-MO, MO
•$56,200 - $101,000•Hybrid
About The Position
This position supervises and facilitates successful interventions to meet behavioral health HEDIS and Pay for Performance measures. The HEDIS Specialist partners with health plans and regional clinical leadership to identify and implement interventions to increase HEDIS rates in behavioral health measures. The ideal candidate will have demonstrated experience improving HEDIS Hybrid measures, including identifying and closing care gaps, implementing targeted interventions, and partnering with health plan and clinical leadership to improve HEDIS measures.
Requirements
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
- Bachelor’s degree in nursing, related field, or equivalent experience.
- 3+ years of experience in case and/or utilization management in a behavioral health or physical health care setting.
- Knowledge of key behavioral or physical health related HEDIS & performance measures required.
Nice To Haves
- Preferred experience in implementing new interventions to affect these rates.
- Supervisory or lead experience preferred.
- Current state’s unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN preferred
Responsibilities
- Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures
- Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources
- Act as a liaison with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes
- Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures
- Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders
- Performs other duties as assigned
- Complies with all policies and standards
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off
- holidays
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
