Manager, Quality Improvement – HEDIS Audit

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Lead and oversee the quality enhancement program, concentrating on the state HEDIS audit and regulatory submission portfolio.

• Direct the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team.

• Assist staff and liaise with departments and personnel to enable daily quality improvement operations.

• Act as a primary escalation point for Health Plans, auditors, and internal collaborators.

• Supervise state HEDIS and regulatory reporting initiatives along with state-specific audit requirements.

• Examine and interpret reports, records, and directives.

• Consult with staff to gather project data, assess work status, and identify issues for planning activities.

• Validate submitted data to ensure compliance with government program requirements, as well as state, federal, and certification standards.

• Generate reports and records detailing work function activities for management's review.

• Oversee the assessment and analysis of reports.

• Review and enhance procedures and practices to achieve work function objectives and maintain compliance with necessary standards.

• Collaborate with departments to document, investigate, and resolve complaints and appeals in line with company and state policies and regulations.

• Monitor and assess costs while partaking in budget preparation.

⛳️ Requirements

• Bachelor’s degree in a relevant field or equivalent experience.

• A minimum of 3 years of experience in clinical, quality management, or healthcare-related roles.

• At least 1 year of recent experience in quality improvement and supervisory roles within a healthcare setting, ideally in managed care.

• Strong understanding of HEDIS, NCQA standards, Medicaid quality reporting, and healthcare regulatory submissions is highly preferred.

• Experience managing complex audit or regulatory programs with multiple concurrent deadlines is strongly preferred.

• Certain states may necessitate formal certification in quality improvement, risk management, or a related field.

• Must have authorization to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Other forms of incentives may be part of the total compensation package.

• Support for accommodations is available.