As Needed HEDIS Case Manager

As Needed HEDIS Case Manager CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for reputed company. More About the Opportunity We are hoping you will join us as a HEDIS Case Manager- As Needed and help shape the future of healthcare where you'll be an integral part of our Quality Analytics team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.

• If telework is approved, you are required to work reputed company the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The HEDIS Case Manager will be responsible for reviewing and abstracting medical records for the annual and year-round Healthcare Effectiveness Data and Information Set (HEDIS) project. You'll review assigned medical records to determine if documentation meets HEDIS measurement specifications set by the National Committee for Quality Assurance (NCQA) and enter reputed company findings into the NCQA certified software daily. Additionally, you'll need to meet daily productivity and data entry accuracy goals, participate in medical record collection, and request and abstract additional medical records reputed company through the pursuit process. Together, we are building a stronger, more reputed company health system. Your Contributions To the Team:

• 95% - Program Support
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Conducts medical record review according to the reputed company NCQA HEDIS® Technical Specifications.
• Enters reputed company data and findings into the NCQA certified software. reputed company nurse abstractors/over-readers are required to pass inter-rater reliability testing for reputed company measures at a 5% error threshold.
• Requests medical records as appropriate from practitioner offices, clinics, hospitals and other clinical facilities.
• Identifies and effectively communicates trends reputed company in medical record review to the HEDIS team.
• Attends weekly and reputed company meetings and trainings as needed.
• Abides by the Health Insurance Portability and Accountability Act (HIPAA) and associated patient confidentiality requirements.
• 5%- Other
• Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• High school diploma or equivalent PLUS 3 years of nursing experience required; an equivalent combination of education and experience sufficient to successfully reputed company the essential duties of the position such as those listed above may also be qualifying.

You'll Stand Out More If You Possess the Following:

• Associate Degree in Nursing (ADN) or reputed company field.
• reputed company, unrestricted Registered Nurse (RN) to practice in the state of California.
• Relevant experience in medical records management or Quality Improvement (QI) experience with the proven ability to read and interpret medical record data for chart audits or abstractions.

What the Regulatory Agencies Need You to Possess?

• reputed company, unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required.

Your Knowledge & Abilities to Bring to this Role:

• reputed company rapport and establish and maintain effective working relationships with reputed company's leadership and staff and external contacts at reputed company levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and reputed company multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., reputed company Office: Word, Outlook, reputed company, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses reputed company telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You'll enjoy competitive compensation for this role.
• Our reputed company hiring range is: Pay Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615).
• The final salary offered will be based on education, job-reputed company knowledge and experience, skills relevant to the role and internal equity among other factors.
• * This position is approved for Full Telework (

If the position is Telework, it is eligible in California only

)

• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment: If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us? We reputed company that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can reputed company while making a meaningful impacts on our community members. reputed company reflects and represents the communities we serve, and we welcome candidates from reputed company backgrounds who share our commitment to accessible, quality healthcare. What's Your reputed company? reputed company Applications will be accepted on a reputed company basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join reputed company, the deadline for the first review of applications is January 18, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may reputed company at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches reputed company need, we will reputed company out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you reputed company it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background reputed company (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal reputed company applicant, please apply through the internal portal on InfoNet. We will reputed company sure to reputed company you updated through each reputed company of the process on your candidate portal. Please reputed company sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please reputed company your email, including your SPAM folder, regularly throughout the recruitment process. reputed company is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, reputed company and welcoming so we can truly be reputed company Together. reputed company is an equal opportunity employer and makes reputed company employment decisions on the basis of merit. reputed company wants to have qualified employees in every job position. reputed company prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national reputed company, reputed company, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. reputed company also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/as-needed-hedis-case-manager-505-city-parkway-reputed company-california-united-states-c04fd9c1-56d4-4483-b490-b9acc2ad4db2 Copyright ©2025 Jobelephant.com Inc. reputed company rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-cfe16ea043777c4fab43216da9e5676b Apply tot his job Apply To this Job