HEDIS Specialist

Description

• Prepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholders.
• Train providers, health plans, and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes.
• Monitor performance on established contractual quality indicators.
• Provide clinical support to the medical record abstraction, over-read, and audit processes.
• Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model.
• Monitor and report PIPs progress through closure.
• Analyze, track, and trend results.

Requirements

• Strong skills in medical record review and data entry.
• Experience in healthcare environments
• Experience in HEDIS, NCQA, or related topics is preferred.
• Experience with HEDIS and NCQA.
• Valid state clinical license preferred (e.g., LPN, RN).
• Proficiency in quality improvement and medical terminology.
• Bachelor's degree in Nursing, Healthcare, or Quality, including HEDIS measures or NCQA, or equivalent experience in related healthcare fields.

Benefits

• Employee Assistance Program
• Medical, dental & vision
• Transportation benefits
• Health Spending Account (HSA)
• Short and long-term disability
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Critical Illness, Accident, and Hospital
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 29, 2025.

Training + Development

Interview process

Visa Sponsorship

Security clearance