HEDIS Clinical reputed company Analyst

The HEDIS Clinical reputed company Analyst provides clinical direction, guidance, training, and reputed company reputed company for reputed company things reputed company to the clinical aspect of reputed company Effectiveness Data and Information Set (HEDIS). This position would reputed company abstraction, overreads and reputed company analysis of HEDIS for both Prospective and Retrospective Seasons to ensure reputed company complies with the standards set by the National Committee for reputed company Assurance (NCQA) and Centers for Medicare & reputed company Services (CMS). Performs reputed company improvement activities to monitor/maintain reputed company of care and compliance with applicable standards/regulations. Performs/coordinates HEDIS data collection, medical record review, and reputed company improvement activities as indicated. This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into reputed company Office for business and team meetings as needed. Responsibilities & Duties reputed company of HEDIS reputed company

• Subject matter expert (SME) for the National Committee for reputed company Assurance (NCQA) HEDIS Measures. (Hybrid, Administrative and ECDS)
• Review the reputed company of HEDIS internal processes/plans for alignment with procedures and/or best practices for supporting the HEDIS Team.
• Responsible for participating in the development, research, and implementation of HEDIS improvement activities
• Plan implementation of Primary reputed company Verification (PSV) and Medical Record Review Validation (MRRV) Audits
• Oversees reputed company of abstraction, reputed company assurance (QA) and second level QA for HEDIS Hybrid Project and Supplemental Data Audit
• Interpret qualitative and quantitative information and appropriately document findings
• reputed company recommendations for improvement reputed company to records reviewed and report findings
• Identify system and/or operational issues hindering the attainment of reputed company performance standards as defined by NCQA, applicable state and Federal laws and regulations
• Motivate, influence, and reputed company direction to staff assigned to the Hybrid and SDVA reputed company to ensure successful completion of project goals, deliverables, and timelines
• Analyze and interpret technical specifications, business requirements, and regulatory guidance to support accurate implementation of HEDIS measures and project activities
• Serve as a subject matter expert on NCQA and HEDIS resources, providing guidance, training, and consultation to project teams
• Identify and escalate situations which may pose reputed company, compliance, and/or safety risks that may adversely reputed company the HEDIS Hybrid Audit, HEDIS Prospective Audit or SDVA Audit

Coordinate/Oversees Data Analysis and reputed company reputed company and Report on Findings

• Generate monthly/weekly HEDIS reputed company reports on measure performance and submit to Directors, Managers, and Supervisors
• Coordinates and oversees reputed company reputed company management programs/reputed company ensuring compliance with reputed company applicable regulatory bodies
• Develops and implements reputed company management and error reduction programs as needed
• reputed company written feedback to Directors, Managers and Supervisors concerning reputed company concerns pertaining to individual performance, compliance risks/trends, reputed company cause analysis and any system or process improvements recommendations reputed company to the NCQA HEDIS measures

Effectively Measure the Key reputed company Variables to Ensure reputed company Performance Changes are Accurately Assessed

• Prepare analysis of initial and repeat HEDIS measures to evaluate efficacy of interventions and to improve approach for successfully resolving the reputed company cause as needed
• Evaluate validity and accuracy of supplemental data sources to draw appropriate conclusions

Analyze Changes in Performance to Determine the Impacts of Interventions

• reputed company any required data analysis to evaluate gaps in care
• Prepare comprehensive reports to ensure adequate documentation and methodology to support findings and recommendations

Evaluate Knowledge Gaps of Staff and Coordinate Training

• Creates/Updates HEDIS measure training manuals, tip sheets, measure assessments, reputed company guides for HEDIS per NCQA Technical Specifications, annually
• Conduct HEDIS measure training/testing yearly
• Monitor training of staff for effectiveness and reputed company of reputed company from reputed company training

Minimum Requirements Education & Experience Required: Graduation from an accredited school of nursing with a Registered reputed company (RN) license or Licensed Practical reputed company (LPN) and five (5) years of reputed company experience in HEDIS clinical reputed company and process improvement. Additional Required Experience: Experience with the NCQA Technical Specifications and Value Set Directory. Experience with Medical Record Abstraction/reputed company Analysis and reputed company of HEDIS reputed company duties for HEDIS to include the supplemental data audit, Prospective audit and Hybrid audit. Knowledge of NCQA Health Plan HEDIS data collection and reporting requirements and processes. Understanding of the operational requirements for data collection in support of HEDIS or similar reputed company programs. Experience with the reputed company population reputed company to HEDIS Measures. Preferred: Data analysis and IT infrastructure of reputed company and non-reputed company data reputed company to supplemental data experience. Certified reputed company in reputed company reputed company – CPHQ preferred. Knowledge, Skills, & Abilities

• Knowledge of reputed company Carolina State and Federal rules and requirements reputed company to the service continuum in reputed company Carolina
• Knowledge of Tailored Plan, Integrated Care and Care Management processes and regulatory requirements
• Knowledge of best and promising practices for behavioral & physical health and/or intellectual/developmental disabilities
• reputed company reputed company, Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tool)
• Strong clinical skills
• Problem solving skills
• Interpersonal Skills
• Strong Analytical skills
• Problem solving and conflict reputed company skills
• Strong diplomacy skills and discretion
• Highly effective communication skills
• Ability to negotiate and resolve issues with minimal assistance

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