Job Profile Summary 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.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.For the Nevada Silver Summit Health Plan only: Driver's license required.For Health Net Federal Services only: Government Security/Clearance/US Citizenship RequirementsResponsibilitiesCoordinate, complete, and update management on clinical quality metrics and HEDIS processes and resultsEstablish and maintain an action plan to improve HEDIS scoresImplement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunitiesCollaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changesManage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and qualityConduct quality audit and maintain all data and process controls to ensure compliancePerforms other duties as assignedComplies with all policies and standards
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $7.25/hr - $80.00/hr.
