HEDIS Coordinator (RN)

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

• Coordinates and completes the annual analysis and HEDIS Medical record data collection and submission to NCQA.
• Support and ensure accuracy/compliancy during the NCQA required MRRV audit
• Coordinates the yearly HEDIS Survey Audit activities of internal departments (Quality, Nurses, Network, Communication/Publications), external provider partners , and contracted vendors (NCQA,).
• Responsible for HEDIS QI Work Plan management and revisions and IL Annual HEDIS Report.
• Attend Quality Improvement Committee and present dashboard on HEDIS and Pay for Performance annual analysis
• Participate in QI activities (Pay for Performance, HEDIS workgroup, CAHPS workgroup)
• Conduct oversee and monitor HEDIS activities throughout the year including submission/presentation of HEDIS reports to health plan quality committees, develop/monitor HEDIS timelines and annual Roadmap revisions.
• Conduct analysis of data and complete annual HEDIS and Pay for Performance reports and playbook
• Conduct HEDIS training for internal and external Quality staff
• Participate in HEDIS temp selection including resume review, interviewing and partnering with plan leadership and External Workforce Services on candidate recommendations
• Serve as liaison between the Enterprise and Illinois Plan
• Monitors NCQA and HEDIS program specifications and translate into report requirements.
• Maintains knowledge of HEDIS report software.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS:

• Registered Nurse (RN) or Clinician with unrestricted, Active license in state of operations
• Bachelor's degree in a related field
• Knowledge of HEDIS Technical Specifications, guidelines and HEDIS survey process
• Minimum of 2 years experience with data analysis.
• Minimum of 2 years in a health care environment.
• Experience with NCQA Survey Requirements and HEDIS reporting.
• Experience utilizing various software packages including Excel, Access, and Word
• QSHR expertise including chase management, report queries, data analysis and clinical assignments

PREFERRED JOB REQUIREMENTS:

• Project Management Experience
• Ability to interpret Quality Compass and understand IDSS rates
• Skilled at managing multiple competing projects in a fast-paced environment with problem-solving abilities
• Health plan knowledge including LOB/products
• Exceptional communication and collaboration skills

#LI-Hybrid

*This role is a hybrid - 3 days in office 2 days work from home at our 300 E. Randolph Location

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.