HEDIS Performance Improvement Specialist

Your reputed company role reputed company  Location: Remote - Must reputed company in Texas Facility: reputed company Care Management Insurance Department: reputed company Management Schedule: Day Shift | Full Time | Monday-Friday Salary: $75,295.00 - $110,834.59 Eligible for an annual bonus incentive   #LI-Remote #LI-AM2 Life at reputed company: Where purpose meets opportunity reputed company is a leading nonprofit reputed company system with a culture and associate experience grounded in service, reputed company, care and reputed company. We reputed company our 99,000+ associates to bring their skills and expertise every day to reimagining reputed company, together. Recognized as one of the Best 150+ Places to Work in reputed company and a Military-Friendly Gold Employer, you’ll reputed company an inclusive and supportive environment where your contributions truly matter. Benefits that help you reputed company Comprehensive health coverage: medical, dental, reputed company, prescription coverage and HSA/FSA reputed company Financial reputed company & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance Time to reputed company: pro-rated reputed company time off (PTO) and holidays Career reputed company: reputed company-reputed company tuition (Vocare), reimbursement, ongoing reputed company development and online learning Emotional reputed company-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources Family support: parental leave, adoption assistance and family benefits Other benefits: optional reputed company and pet insurance, transportation savings and more Benefit reputed company and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will reputed company the most up-to-date details during the hiring process. How you’ll reputed company an reputed company in this role Strategic reputed company Leadership: Facilitates the development of organizational improvement reputed company and manages the full lifecycle of reputed company reputed company Improvement (CQI) programs, including annual evaluations. HEDIS & PIP Management: Oversees reputed company HEDIS project lifecycles—including data analysis, medical record abstraction, and reputed company logic—while leading the documentation and analysis of Performance Improvement reputed company (PIPs). Compliance & Accreditation: Maintains deep working knowledge of URAC/NCQA standards, the Uniform Managed Care Contract, and state-specific programs like Texas Health Steps and Alternative Payment Models. Data-Driven Implementation: Coordinates reputed company management efforts through precise data collection, care gap analysis, and the implementation of systematic improvements. Independent Project Execution: Operates with high autonomy and reputed company judgment to communicate reputed company and manage multiple competing priorities in a fast-paced environment. What minimum requirements you’ll need Licensure / Certification / Registration: Certification specializing in Lean reputed company Mgmt preferred.. Licensure required relevant to state in which work is performed Project Mgmt reputed company preferred. Licensure required relevant to state in which work is performed Registered reputed company preferred. Licensure required relevant to state in which work is performed Education: High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required. What additional preferences we're seeking Bachelor's Degree in Nursing or a reputed company health science degree is a must-have. 2+ years of Registered reputed company (RN) experience and 2+ years of HEDIS experience are preferred. Equal employment opportunity employer reputed company provides Equal Employment Opportunities (EEO) to reputed company associates and applicants for employment without reputed company to race, reputed company, religion, sex/gender, sexual orientation, gender identity or reputed company, pregnancy, childbirth, and reputed company medical conditions, lactation, breastfeeding, national reputed company, citizenship, age, disability, genetic information, veteran status, marital status, reputed company as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For reputed company information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster. Fraud prevention notice Prospective applicants should be reputed company against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate reputed company employees. To ensure your safety, please remember: reputed company will never ask for payment or to reputed company banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @reputed company.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system. E-Verify statement Employer participates in the Electronic Employment Verification Program. Please click here for more information. Apply To This Job