Job Description:
Job Title: Clinical - HEDIS Specialist
Assignment Duration: 7 Months (Possible extensions)
Work Location: Fully Remote
Schedule: Monday Friday, 8:00 AM 5:00 PM
Work Type: Remote
Position Overview
The Clinical HEDIS Specialist supports the quality improvement initiatives by driving compliance with key HEDIS and Pay for Performance (P4P) measures. This role is instrumental during annual 4th quarter care gap closure project and will transition into the HEDIS hybrid season in January.
This is a fully remote, national position focused on improving clinical quality metrics through data abstraction, collaboration with clinical teams, and implementation of innovative performance strategies.
Key Responsibilities
Develop and implement strategies in collaboration with clinical and quality teams to enhance compliance with behavioral health and medical HEDIS metrics.
Prepare and present financial impact and return on investment (ROI) analyses for initiatives requiring additional funding or resources.
Monitor the effectiveness of existing and new HEDIS initiatives, ensuring appropriate knowledge sharing, staff education, and intervention follow-up.
Perform accurate medical record abstraction and data validation for HEDIS measures according to NCQA and organizational standards.
Partner cross-functionally with providers, data analytics teams, and internal stakeholders to track and close care gaps efficiently.
Maintain up-to-date documentation, ensuring adherence to Centene's policies, standards, and data integrity requirements.
Perform other related duties as assigned.
Qualifications
Education & Experience
Required:
Bachelor's degree in Nursing, Healthcare Administration, or related field; or equivalent combination of education and experience.
Minimum of 3+ years of experience in healthcare quality, clinical abstraction, or HEDIS projects.
Preferred:
Strong knowledge of HEDIS measures, hybrid methodology, and NCQA guidelines.
Experience working within a managed care organization or health plan setting.
Licensure
Required: RN, BSN, or LPN (active and unrestricted license).
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