Position Summary
The HEDIS Champion will serve as a key resource in driving quality improvement initiatives across the organization, ensuring compliance with HEDIS (Healthcare Effectiveness Data and Information Set) measures and managed care standards. This role requires a proactive, detail-oriented professional with a strong background in managed care, quality metrics, and HEDIS reporting. The HEDIS Champion will collaborate closely with providers, office staff, and leadership to optimize performance on quality measures and enhance patient outcomes.
Essential Responsibilities
- HEDIS Compliance & Quality Oversight
- Monitor, track, and report HEDIS performance metrics across all clinical sites.
- Ensure adherence to NCQA, CMS, and Medicare Advantage quality standards.
- Identify gaps in care and implement strategies to close them effectively.
- Data Collection & Analysis
- Conduct medical chart reviews and validate data for accuracy.
- Upload HEDIS data into health plan portals and maintain organized records.
- Analyze trends and prepare detailed reports for leadership review.
- Provider & Staff Education
- Train providers and office teams on HEDIS requirements, managed care protocols, and documentation best practices.
- Serve as a subject matter expert for quality improvement initiatives.
- Strategic Quality Improvement
- Develop and execute action plans to improve HEDIS scores and overall quality performance.
- Collaborate with clinical leadership to align quality goals with organizational objectives.
- Travel & On-Site Support
- Provide hands-on assistance at multiple office locations to ensure compliance and support staff.
- Act as a liaison between clinical teams and leadership for quality-related concerns.
Required Qualifications
Education:
Must hold one of the following licenses : Licensed Practical Nurse (LPN).
- Experience:
- Minimum 1–2 years in managed care and HEDIS-related work.
- Familiarity with NCQA, CMS quality measures, and Medicare Advantage programs.
- Skills:
- Strong analytical and organizational skills.
- Excellent verbal and written communication.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
- Other Requirements:
- Ability to travel as needed.
- Comfortable working in a fast-paced, multi-site environment.
Preferred Qualifications
- Clinical background (LPN) or prior experience in quality improvement roles.
- Knowledge of medical terminology and electronic health record systems.
Pay: $20.00 per hour
License/Certification:
Work Location: On the road
