HEDIS Performance Improvement Specialist

About the role

Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI). Assist in educating new staff, providers about the quality improvement (QI) systems and requirements. Oversees complex HEDIS project lifecycles including data analysis, medical record abstraction, chase logic, thorough knowledge or Performance Improvement Projects (PIPs) and applies that knowledge in PIP writing development, update, and analysis of data in PIPs. Maintains deep working knowledge of URAC/NCQA standards, the Uniform Managed Care Contract, and state-specific programs like Texas Health Steps and Alternative Payment Models. Analyze HEDIS data to develop interventions for gaps in care.

Responsibilities

• Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI).
• Aid in educating new staff and providers on the quality improvement (QI) systems and requirements.
• Oversee complex HEDIS project lifecycles including data analysis, medical record abstraction, chase logic, thorough knowledge or Performance Improvement Projects (PIPs).
• Apply knowledge in PIP writing development, update, and analysis of data in PIPs.
• 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.
• Analyze HEDIS data to develop interventions for gaps in care.

Requirements

• Licensure / Certification / Registration: Certification specializing in Lean Healthcare Mgmt preferred.
• Licensure required relevant to state in which work is performed.
• Project Mgmt Professional preferred.
• Licensure required relevant to state in which work is performed.
• Education: 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.

Qualifications

• Bachelor's Degree in Nursing is a must-have.
• 2+ years of Registered Nurse (RN) experience and 2+ years of HEDIS experience.
• Performance Improvement Projects (PIP) experience.

Skills

• Knowledge of quality improvement principles, practices and procedures.
• Experience with HEDIS project lifecycle.
• Understanding of URAC/NCQA standards, the Uniform Managed Care Contract, and state-specific programs.
• Ability to analyze HEDIS data to develop interventions for gaps in care.
• Strong project management skills.
• Effective communication and teaching abilities.

Benefits

• Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options.
• Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance.
• Time to recharge: pro-rated paid time off (PTO) and holidays.
• Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning.
• Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources.
• Family support: parental leave, adoption assistance and family benefits.
• Optional legal and pet insurance, transportation savings and more.

Pay

$75,295.00 - $110,834.59 annually

Schedule

Day Shift | Full Time | Monday-Friday