HEDIS Specialist

Centene Corporation is hiring a HEDIS Specialist to improve behavioral health HEDIS and Pay for Performance measures. The role develops and monitors interventions, analyzes quality and clinical improvement opportunities, and partners with health plans and clinical leaders to improve measure rates.

Responsibilities

Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures

Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources

Act as a liasion with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes

Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures

Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders

Performs other duties as assigned

Complies with all policies and standards

Preferred

The ideal candidate will have demonstrated experience improving HEDIS Hybrid measures, including identifying and closing care gaps, implementing targeted interventions, and partnering with health plan and clinical leadership to improve HEDIS measures

preferred experience in implementing new interventions to affect these rates

Supervisory or lead experience preferred

Current state's unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN preferred

HEDIS Hybrid Measures

Care Gap Identification

Care Gap Closure

Targeted Intervention Implementation

HEDIS Measure Improvement

LCSW

LMFT

LPC

PhD

PsyD

RN

Collaboration

Supervisory Experience

Leadership

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

A flexible approach to work with remote, hybrid, field or office work schedules

Total compensation may also include additional forms of incentives.

Company

Managed care health plans for Medicaid, Medicare, and Marketplace

Saint Louis, Missouri, USA

http://centene.com/

Founded in 1984

10001+ employees

Qualifications

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future

Bachelor's degree in nursing, related field, or equivalent experience

3+ years of experience in case and/or utilization management in a behavioral health or physical health care setting

Knowledge of key behavioral or physical health related HEDIS & performance measures required

The ideal candidate will have demonstrated experience improving HEDIS Hybrid measures, including identifying and closing care gaps, implementing targeted interventions, and partnering with health plan and clinical leadership to improve HEDIS measures

Preferred experience in implementing new interventions to affect these rates

Supervisory or lead experience preferred

Current state's unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN preferred

3+ years of experience in case and/or utilization management in a behavioral health or physical health care setting.

Required skills

Represents the skills you have, click on the tags, HEDIS Measures, HEDIS Hybrid Measures, Behavioral Health, Case Management, Utilization Management, Pay for Performance (P4P) Measures, LCSW License, LMFT License, LPC License, PhD, PsyD, RN License

Preferred skills

Supervisory or lead experience preferred

Experience

3+ years