Manager, Quality Improvement, HEDIS Audit
Core
Oversee and manage the functions of the quality improvement program, specifically leading the state HEDIS audit and regulatory submission portfolio.
Role type
Manager, Quality Improvement & Regulatory Audits
Builds
State HEDIS and regulatory reporting programs
Domain
Healthcare / Managed Care / Quality Assurance
Deliverable
dashboards & analysis
Required skills
HEDIS knowledge, NCQA requirements, Medicaid quality reporting, healthcare regulatory submissions, audit program leadership, budget monitoring, complaint/appeal resolution
Preferred skills
Clinical or quality management experience, supervisory experience in managed care, leading complex audit programs with multiple deadlines
Technologies
None stated
Responsibilities
Serve as key escalation point for Health Plans, auditors, and internal partners; Review and analyze reports, records and directives; Confer with staff to obtain data and verify data for submission; Prepare reports and records on work function activities; Evaluate current procedures to develop and implement improved practices; Collaborate to document, investigate and resolve complaints and appeals; Monitor and analyze costs and participate in budget preparation
Seniority
Manager, supervisory level
