HEDIS Audit Quality Manager – State, NCQA

• Manage all HEDIS Audit activities for lines of business, regions, markets, and/or enterprise-wide submissions
• Interface with internal and external clients, quality committees, and departments regarding HEDIS submissions and requirements
• Manage HEDIS audit processes and resources
• Evaluate, interpret, and summarize HEDIS audit guidelines
• Manage HEDIS submission activities
• Identify resources and accountabilities for HEDIS audit project teams
• Evaluate and interpret NCQA, CMA, and State HEDIS requirements
• Serve as an expert resource to quality committees and business owners
• Lead and oversee quality studies and projects
• Facilitate project management and develop HEDIS audit work plans
• Establish deliverables, accountabilities, and timelines
• Perform quantitative and qualitative analysis of quality data
• Report activities, improvements, and recommendations to quality committees
• Coordinate with health plans on state-specific audits and reporting requirements

• BA/BS in a health care field
• Minimum of 3 years healthcare-related experience
• Minimum of 3 years’ experience in a QA/QI related position
• Extensive experience managing overall HEDIS audit processes preferred
• Strong knowledge of NCQA HEDIS audit guidelines and processes preferred
• Experience creating and managing large project plans
• Experience leading mock interviews for external HEDIS audits
• HEDIS audit experience preferred
• Medicaid experience preferred
• Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted

Demonstrates expertise in managing HEDIS audit activities, including evaluation of NCQA and state requirements, while effectively coordinating with internal and external stakeholders. Proficient in project management, data analysis, and leading quality improvement initiatives within the healthcare sector.

• HEDIS Audit Management
• NCQA Guidelines Knowledge
• Quality Assurance/Quality Improvement Experience