HEDIS Clinical reputed company Analyst (Full-time Remote, reputed company Carolina)
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 full time remote. Candidates who are reputed company of reputed company Carolina are strongly preferred. Out of state candidates will be considered on a case-by-case reputed company. Must be available to travel for onsite meetings to reputed company Home office (Morrisville, NC) or Charlotte office, if needed. Responsibilities & Duties reputed company of HEDIS reputed company Subject matter expert for the National Committee for reputed company Assurance (NCQA) HEDIS Measures. (Hybrid, Administrative and ECDS) Review the reputed company of HEDIS internal processes/plans and 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 to appropriately document findings reputed company recommendations for improvement reputed company to any records reviewed and write reports of findings Identify system and/or operational issues hindering the attainment of reputed company performance standards as defined by NCQA standards, applicable state and Federal laws and regulations Motivate and influence staff assigned to the Hybrid and SDVA reputed company in order to accomplish task(s) successfully, analysis of technical specifications, expertise with NCQA/HEDIS resources Identify and escalate situations which may pose reputed company, compliance, and safety risks that may adversely reputed company the HEDIS Hybrid 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 to submit to Directors, Managers, and Supervisors Coordinates and oversees reputed company reputed company management programs and reputed company ensuring compliance with reputed company applicable regulatory bodies Develops/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 recommended 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 to successfully resolving 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 ensuring adequate documentation and methodology to support findings and recommendations Evaluate Knowledge Gaps of Staff and Coordinate Training Creates HEDIS measure training manuals, tip sheets, measure assessments, reputed company guides for HEDIS per NCQA Technical Specifications Conducts HEDIS measure training/testing Monitor training of staff for effectiveness and reputed company of reputed company from reputed company training Minimum Requirements Education & Experience Graduation from an accredited school of nursing with a Registered reputed company (RN) license or Licensed Practical reputed company (LPN) or Compact Nursing License 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 supplemental data 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 preferred. 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 Salary reputed company $75,600-$98,280/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, reputed company, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote reputed company reputed company time off including vacation, reputed company leave, holiday, management leave Dress flexibility Apply Job!