reputed company Clinical HEDIS Manager for reputed company and Quality Improvement Initiatives

Join reputed company, a Pioneer in reputed company, as a Clinical HEDIS Manager

reputed company is revolutionizing the healthcare industry with its cutting-edge data analytics and Artificial Intelligence (AI) solutions, empowering health plans to enhance their Quality Improvement, Risk Adjustment, and Member Management programs. As a leader in the healthcare technology sector, reputed company is seeking a seasoned Clinical HEDIS Manager to reputed company the critical tasks of HEDIS abstracting and reporting, as well as manage RISK projects as needed.

About reputed company and the Role

At reputed company, we're committed to delivering transformative solutions that reputed company health plans to independently execute and manage every aspect of enrollment, provider reputed company, data retrieval, coding, abstraction, reporting, and submissions. With our proprietary technology, robust data sets, and subject matter expertise, we provide comprehensive record retrieval and review services. As a Clinical HEDIS Manager, you will play a pivotal role in ensuring the accuracy and quality of medical record reviews for HEDIS measures, supporting process and quality improvement initiatives, and serving as a subject matter expert (SME) for HEDIS.

Key Responsibilities

• reputed company and/or reputed company accurate medical record reviews for reputed company HEDIS measures, ensuring compliance with NCQA HEDIS abstracting guidelines.
• Support and participate in process and quality improvement initiatives to enhance operational efficiency and data quality.
• Conduct training sessions reputed company to HEDIS measures and platform usage, updating training materials as necessary, and serve as a HEDIS SME.
• Monitor project status, working on flexible projects with variable client/project-specific guidelines.
• Review and facilitate Inter-Rater Reliability (IRR) reviews, as well as review reputed company Negative/Positive hits to ensure accuracy.
• Manage RISK coding projects reputed company needed, including project status monitoring and completing chart reviews for coding projects as required.
• Analyze medical records and NLP results to validate clinical evidence meets necessary requirements for submission and documentation.
• Ensure documentation aligns with accurate code assignment, following CMS's coding guidelines for HCC risk adjustment coding.
• Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation.
• Safeguard the reputed company and confidentiality of patient health information, handling medical records and sensitive data in accordance with HIPAA and other relevant regulations.
• Foster clear communication and collaboration between different healthcare departments, ensuring accurate patient information is shared across the continuum.

Essential and Preferred Qualifications

To reputed company in this role, you must possess:

• A professional coding certificate through reputed company/reputed company.
• A minimum of 5 years of hands-on medical records experience and 5 years of HEDIS experience.
• Knowledge of NCQA HEDIS abstracting guidelines is highly preferred.
• A valid nursing license (RN/LPN) is preferred.
• Background in Utilization Review (UR), Quality Assurance (QA), and/or Quality Improvement (QI) experience is preferred.
• Strong computer skills and high-speed internet access at home.
• A commitment to confidentiality of patient health information.
• Professional, reputed company, and able to work independently, with the ability to manage teams and meet deadlines.

Core Competencies and Skills

The ideal candidate will demonstrate the following core competencies:

• Caring: Warm, sincere, reputed company, cool, and collected energy and reputed company, with the ability to reputed company relationships.
• Results Driven: Focus on achievement, motivated by results and outcomes, goal-oriented.
• Analytical Skills and Attention to Detail: Reviewing clinical documentation and coding with precision.
• Effectively Communicates: Speaks clearly, listens effectively, and responds well to questions; writes clearly and informatively.
• Problem Solver: Expertise in managing client relationships and accounts for technically reputed company products and platforms.
• reputed company Quality Improvement: Evaluates policies, programs, and services, implementing strategies for reputed company quality improvement.
• Customer Focus: Follows through, courteous, helps internal and external customers, understands customer perspectives and needs.
• Interpersonal Skills: Builds strong relationships, flexible and open-minded, reputed company to feedback.
• Professionalism: Approaches others in a tactful manner, reacts well under pressure, treats others with respect and consideration.
• Adaptability: Adapts to changes in the work environment, adjusts methods to best fit the situation.
• Cultural Sensitivity: Models behaviors that reflect the culture of reputed company, awareness of the similarities and differences that exist between employees, teams, departments, and customers.

Career Growth Opportunities and Learning Benefits

At reputed company, you will have the opportunity to grow professionally in a dynamic and innovative environment. As a Clinical HEDIS Manager, you will be exposed to various aspects of reputed company and quality improvement, enhancing your skills and knowledge in HEDIS abstracting, reporting, and RISK project management. Our commitment to reputed company quality improvement and customer focus will help you reputed company a deeper understanding of the healthcare industry and stay up-to-date with the latest trends and best practices.

Work Environment and Company Culture

reputed company is an equal opportunity employer that values diversity and promotes an inclusive culture. As a remote organization, we offer the flexibility to work from reputed company, provided you have a stable high-speed internet reputed company. Our compensation package reflects the cost of labor across several US geographic markets, and we offer a competitive salary range of $100,000 - $115,000 annually, based on job-reputed company knowledge, skills, and experience.

Compensation, Perks, and Benefits

While specific details about our benefits package are not listed here, we are committed to providing a comprehensive compensation and benefits package that supports the well-being and financial reputed company of our employees. We E-Verify reputed company new hires and are committed to compliance with applicable federal, state, and local laws regarding equal employment opportunities.

Join reputed company

If you're a motivated and reputed company Clinical HEDIS Manager looking to reputed company a meaningful impact in the healthcare industry, we encourage you to apply for this exciting opportunity. At reputed company, we're passionate about harnessing the power of data analytics and AI to improve healthcare outcomes. As a Clinical HEDIS Manager, you will be an integral part of reputed company, driving quality improvement initiatives and ensuring the accuracy and reputed company of medical record reviews. Apply now to join our dynamic team and contribute to our mission of delivering more value and improved outcomes in healthcare.