Clinical - HEDIS Coordinator - 210403 - Full-time
100 % Remote Role No specific time zone required 8 hours/day, No OT, 40/hrs /week Duration: 6 months contract Target Start Date: 11/3/2025 Job Description: Position Purpose: Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas. Education/Experience: Bachelor s degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred. Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality Story Behind the Need Business Group & Key Projects • Health plan or business unit • Team culture • Surrounding team & key projects • Purpose of this team • Reason for the request • Motivators for this need • Any additional upcoming hiring needs? Needing a HEDIS Specialist to assist with record review and auditing through Q4 and into HEDIS Hybrid project. Our drive to is to reach the highest star rating for our plan. Must have HEDIS experience and HEDIS measure knowledge. Previous experience required. Any knowledge of QMRM and QCAT a bonus. Typical Day in the Role • Daily schedule & OT expectations • Typical task breakdown and rhythm • Interaction level with team • Work environment description 8 hour days, no OT. Review 40-80 medical records for compliance and submit for HEDIS gap closure. Covers Medicaid, Medicare and Marketplace LOB. Will be fully integrated with other HEDIS staff. Work is remote. Must be driven and have a strong work ethic. Compelling Story & Candidate Value Proposition • What makes this role interesting? • Points about team culture • Competitive market comparison • Unique selling points • Value added or experience gained Satisfaction of knowing our members are being taken care of by providers. Very strong team already in place with a great team collaboration environment. Candidate Requirements Education/Certification Required: Bachelor s Degree Preferred: Licensure Required: Preferred: • Years of experience required • * Best vs. average • Performance indicators Must haves: Strong HEDIS knowledge, including measure knowledge Nice to haves: Experience with QMRM/Inovalon and QCAT programs Disqualifiers: No HEDIS or measure knowledge Performance indicators: Strong work ethic. Must maintain a approval rate of 95% or higher for medical record reviews • Top 3 must-have hard skills • Level of experience with each • Stack-ranked by importance • Candidate Review & Selection 1 Strong HEDIS skills and Work Ethic 2 At least 3 years experience with HEDIS 3 Ability to work in a remote environment and complete set goals to drive results 100 % Remote Role No specific time zone required 8 hours/day, No OT, 40/hrs /week Duration: 6 months contract Target Start Date: 11/3/2025 Job Description: Position Purpose: Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas. Education/Experience: Bachelor s degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred. Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality Story Behind the Need Business Group & Key Projects • Health plan or business unit • Team culture • Surrounding team & key projects • Purpose of this team • Reason for the request • Motivators for this need • Any additional upcoming hiring needs? Needing a HEDIS Specialist to assist with record review and auditing through Q4 and into HEDIS Hybrid project. Our drive to is to reach the highest star rating for our plan. Must have HEDIS experience and HEDIS measure knowledge. Previous experience required. Any knowledge of QMRM and QCAT a bonus. Typical Day in the Role • Daily schedule & OT expectations • Typical task breakdown and rhythm • Interaction level with team • Work environment description 8 hour days, no OT. Review 40-80 medical records for compliance and submit for HEDIS gap closure. Covers Medicaid, Medicare and Marketplace LOB. Will be fully integrated with other HEDIS staff. Work is remote. Must be driven and have a strong work ethic. Compelling Story & Candidate Value Proposition • What makes this role interesting? • Points about team culture • Competitive market comparison • Unique selling points • Value added or experience gained Satisfaction of knowing our members are being taken care of by providers. Very strong team already in place with a great team collaboration environment. Candidate Requirements Education/Certification Required: Bachelor s Degree Preferred: Licensure Required: Preferred: • Years of experience required • * Best vs. average • Performance indicators Must haves: Strong HEDIS knowledge, including measure knowledge Nice to haves: Experience with QMRM/Inovalon and QCAT programs Disqualifiers: No HEDIS or measure knowledge Performance indicators: Strong work ethic. Must maintain a approval rate of 95% or higher for medical record reviews • Top 3 must-have hard skills • Level of experience with each • Stack-ranked by importance • Candidate Review & Selection 1 Strong HEDIS skills and Work Ethic 2 At least 3 years experience with HEDIS 3 Ability to work in a remote environment and complete set goals to drive results Apply tot his job