Hedis Coordinator Remote Jobs in Riverside, CA (NOW HIRING)

Description

JOB SUMMARY:

The Preventative Care Advocate supports Quality Improvement and Population Health initiatives within a Managed Services Organization (MSO) serving an Independent Practice Association (IPA) network. This role is responsible for promoting compliance with Healthcare Effectiveness Data and Information Set (HEDIS), CMS Star Ratings, NCQA accreditation standards, DMHC regulatory requirements, and contracted health plan quality programs.

The Preventative Care Advocate works directly with contracted provider offices to improve preventive care delivery, close care  gaps, and enhance clinical documentation and quality performance. This position serves as a liaison between the MSO, IPA providers, and health plan partners to facilitate quality improvement initiatives, support audit readiness, and improve overall patient outcomes and performance metrics.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS:

Education/Training

Minimum: High school diploma or equivalent required.

Preferred: Associate's degree or higher in healthcare administration, public health, social services, or related field. Certification as a Medical Assistant.

Experience 

Minimum: At least two years of experience in healthcare operations, quality improvement, medical office operations, care coordination, or managed care environment.

Preferred: Experience supporting HEDIS, CMS Star Ratings, or NCQA quality programs. Experience working in an MSO, IPA, or managed care organization. Experience supporting Medicare Advantage, Medi-Cal, or commercial populations. Experience with medical record abstraction and quality reporting processes.

Certification(s)

Certified Professional in Healthcare Quality (CPHQ), Medical Assistant certification, or related healthcare certification preferred.

Skills, Knowledge & Abilities

• Knowledge of HEDIS measures and preventive care quality standards preferred.
• Understanding of NCQA, CMS, DMHC, and health plan quality program requirements preferred.
• Knowledge of preventive care guidelines and population health principles.
• Proficiency in Microsoft Office applications, including Excel and PowerPoint.
• Ability to work with electronic health record systems and quality reporting tools.
• Strong organizational and tracking skills.
• Excellent verbal and written communication skills.
• Ability to educate and engage provider offices and interdisciplinary teams.
• Ability to establish and maintain effective working relationships.
• Strong attention to detail and data accuracy.
• Ability to manage multiple priorities and deadlines.
• Ability to work independently and collaboratively.
• Bilingual (Spanish or other threshold language) preferred.
• Knowledge of managed care and IPA environments preferred.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Primarily sedentary work involving prolonged computer use. Frequent standing, walking, and travel to provider offices may be required. Occasional lifting of up to 10 pounds may be necessary. Requires the ability to analyze performance data, maintain attention to detail, and communicate effectively. Work is performed in office, remote, and provider office environments, with frequent use of electronic systems and reporting tools.

PAY RANGE 

$33.65 - $35.10 / hourly