Hedis Coordinator

Centene Corporation Des Moines , IA 50301

Posted 7 days ago

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.

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

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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Director Hedis Operations

Centene Corporation

Posted 3 weeks ago

VIEW JOBS 2/21/2019 12:00:00 AM 2019-05-22T00:00 Position Purpose: Research, identify, and implement best practices to improve HEDIS measures and risk adjustment data capture into operations in collaboration with various departments Direct activities, resources, methods, and procedures to achieve improvement in HEDIS measures Formulate and ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines Review and implement new technological tools and processes that support HEDIS measure and risk adjustment reporting and submission to foster team concept with internal and external stakeholders Collaborate with all internal and external stakeholders in identifying, developing, and implementing innovative programs and initiatives to improve HEDIS measures Provide comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to health plan leadership, including support of risk adjustment programs and medical record retrieval (MRR)Provide leadership and direction on initiatives set to improve HEDIS measures to ensure best in class outcomes. Collaborate with internal and external stakeholders to ensure HEDIS initiatives are fully integrated throughout the business unit, maximizing opportunity to improve outcomes for members. Ability to analyze, interpret, and execute programs using data driven reporting methodology and strategy. Education/Experience: Bachelor's degree in Nursing, Business Administration, or Health Care Administration. Master's degree preferred. 7 years of experience in healthcare management (medical management and/or quality improvement). Advanced working knowledge of HEDIS technical specifications. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Quality improvement experience preferred. Advanced knowledge of analytics and reporting preferred. Experience leading or supporting Risk Adjustment programs(including coding and medical record retrieval) preferred. Experience managing a successful HEDIS Hybrid season is preferred. License/Certification: RN or Certified Professional in Health Care Quality. Certified Professional Coder (CPC) preferred. Western Sky Community Care: RN preferred Centene Corporation Des Moines IA

Hedis Coordinator

Centene Corporation