Quality Improvement Specialist (HEDIS) II
Core
Lead the development and maintenance of quality improvement projects for HEDIS Hybrid Operations, serving as the primary owner for assigned HEDIS measures.
Role type
Senior Quality Improvement Specialist (HEDIS)
Builds
Quality performance improvement plans (PIPs) and strategies for health plans
Domain
Healthcare / Health Insurance / Quality Measurement
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Clinical medical record abstraction, HEDIS measure interpretation, PDSA model implementation, data analysis and trending, team training, gap identification, inter-rater reliability (IRR) management
Preferred skills
Knowledge of NCQA standards, experience with complex or high-risk HEDIS measures, market-wide impact strategy planning
Technologies
PDSA model, HEDIS abstraction tools
Responsibilities
Train providers and staff on continuous quality improvement and HEDIS processes; Monitor performance on contractual quality indicators; Analyze and track quality results; Recommend and implement quality performance improvement plans; Serve as primary owner for assigned HEDIS measures including pseudo-claims performance; Provide clinical support for medical record audit processes; Mentor team members on abstraction standards and measure interpretation
Seniority
Senior, hands-on IC with mentorship responsibilities
