HEDIS Quality Improvement

About the role

Ultimate Staffing Services is actively seeking a highly skilled HEDIS Quality Improvement Specialist to join a dedicated Quality Management team in Morrisville, North Carolina (hybrid). This role involves serving as a subject matter expert in HEDIS, supporting quality improvement initiatives, medical record review, data validation, audit readiness, and regulatory compliance. The ideal candidate will have a robust background in HEDIS, NCQA standards, medical record abstraction, and healthcare quality improvement, along with experience working within Medicaid and/or managed care environments.

Responsibilities

• Serve as a subject matter expert (SME) for NCQA HEDIS measures, including Hybrid, Administrative, and ECDS measures.
• Coordinate and support HEDIS projects through planning, execution, monitoring, and completion.
• Monitor project timelines, deliverables, and audit readiness activities.
• Identify risks and implement solutions to ensure successful project outcomes.
• Conduct medical record abstraction and validation activities.
• Perform quality assurance reviews to ensure accuracy and compliance with HEDIS specifications.
• Support Supplemental Data Validation Audits (SDVA), Medical Record Review Validation (MRRV), and other audit-related processes.
• Assist with primary source verification and data integrity initiatives.
• Analyze HEDIS performance data and identify opportunities for improvement.
• Assist with gap-in-care analysis and quality improvement initiatives.
• Develop reports and recommendations that support organizational quality goals.
• Collaborate with cross-functional teams to implement performance improvement strategies.
• Develop and maintain HEDIS training materials, tip sheets, documentation guides, and educational resources.
• Deliver HEDIS measure training and competency assessments.
• Provide ongoing education and support to internal teams and stakeholders regarding HEDIS requirements and best practices.

Qualifications

• Required Education & Credentials:
  • Associate Degree in Nursing and active RN licensure
  • Licensed Practical Nurse (LPN) license
  • Graduation from an accredited coding program with Certified Professional Coder (CPC) certification
• Required Experience:
  • 3+ years of HEDIS clinical quality and process improvement experience for RN candidates OR 5+ years of HEDIS clinical quality and process improvement experience for LPN or CPC candidates
  • Experience with NCQA HEDIS Technical Specifications
  • Experience with medical record abstraction and quality review
  • Knowledge of HEDIS data collection and reporting requirements
  • Experience supporting healthcare quality improvement initiatives
  • Familiarity with Value Set Directory (VSD)
  • Experience working with Medicaid populations
• Preferred Qualifications:
  • Managed care or health plan experience
  • NCQA audit experience
  • Experience with Supplemental Data Validation Audits (SDVA)
  • Healthcare analytics and reporting experience
  • Lean, Six Sigma, Kaizen, or other quality improvement methodologies
  • Experience developing and delivering training programs

Benefits

• Medical
• Dental
• Vision
• Pharmacy

Pay

Salary Range: $35 - $40 per hour

Schedule

Monday - Friday, 1st shift