HEIDS RN

Large managed care company is looking for a part-time HEDIS RN to be responsible for creating, driving and executing strategy to ensure optimal HEDIS® and CAHPS® results for the client.

Work Location: FULLY REMOTE

Pay: $40.00

Contract Dates: ASAP - 3/1/2025

Hours: Monday – Friday, between 8-5 - TWELVE (12) HOURS A WEEK ONLY

JOB SUMMARY

Provides strategic leadership and direction for the quality improvement program to the E&I line of business. The individual is needed to work with the UHC National Account team and their customer to improve their Clinical Quality, Customer Service and Resource Use (QCR) measures rates required by the Office of Personnel Management (OPM). .

RESPONSIBILITIES

• Drives programs and initiatives to assure member access to care and gaps in care closure.
• Under the supervision of the RVP, partners with the National Account team for client to establish and ensure goals are met.
• Complete an analysis on HEDIS® & CAHPS® measures data to identify areas of opportunity to improve the rates.
  
• Partnering with the HEDIS team to collect data, including developing strategies, prioritization and assistance with the daily collection management.
• Improving CAHPS scores by working with their National Account team to develop initiatives to enhance member experience with their health plan and health care providers.
• Work closely with the client team and the UHC National Account team dedicated to develop programs and educational material focusing on increasing the member's compliance of the preventive health services needed to improve the HEDIS® measure rates.
• Complete with client any corrective action plans needed for Office of Personal Management (OPM) and provide quarterly updates as required.
• Work with the National Account reporting team to develop reports for client to assist them to monitor their HEDIS® measure preliminary rates.
• Displays innovative problem solving and upholds principles of continuous quality improvement.
• Monitors daily, weekly, monthly, quarterly, semi-annual and annual reports against goals to assess program success and alignment and to identify opportunities for improvement.
• Accountability for and knowledge of the Quality Improvement and gap metrics for assigned market/state. Appropriate application of information to drive strategy within the market.

QUALIFICATIONS

• Clinical background required (e.g. RN, Nurse-practitioner, Pharmacist, MSW, MD)
• BA/BS degree in healthcare related field; or Clinical Registered RN with ADN degree is acceptable with commensurate demonstrated clinical experience or outcomes specified below.
• Subject matter expertise in Clinical Quality, Accreditation, HEDIS® and/or CAHPS®, Health Plan operations, HMO/PPO, Utilization Management, Population Health Management; Provider practice management, Regulatory requirements, etc.
• 3+ years of experience in, and/or knowledge of, Clinical Quality and Quality Improvement processes required. NCQA Accreditation, HEDIS and CAHPS expertise preferred.
• 5-7 years working in managed care or a healthcare delivery system preferred.
• Ability to work independently with minimal supervision.
• Ability to work in a complex and highly-matrixed environment is essential.
• Ability to communicate technical concepts effectively to non-technical senior leaders (CEO, CFO, etc.).