HEDIS Clinical Lead I

Job Locations US-CA-Fairfield
Job ID
2021-2100
FLSA Status
Exempt

Overview

As a Clinical Lead, responsible to lead clinical quality initiatives within the Quality and
Performance Improvement Department. Evaluates performance of Partnership HealthPlan in key
clinical preventative and chronic care measures. Works closely with the Quality Improvement
(QI) team to identify and implement interventions that focus on improving performance in
various quality measures that collect data, including Healthcare Effectiveness Data &
Information Set (HEDIS) Works as clinical liaison to contracted auditing agencies/firms and the
National Committee for Quality Assurance (NCQA). Functions as subject matter expert on all
clinical quality performance measures within the HEDIS Quality Measurement Set applicable to
Department of Health Care Services (DHCS) and NCQA HEDIS Accreditation (HACCRD)
reporting with an emphasis on Hybrid specifications.

Responsibilities

  • Develops and implements trainings for clinical staff performing HEDIS medical record
    reviews.
  • With day to day oversight and collaboration from the Sr. Clinical Lead, effectively
    oversees HEDIS clinical activities.
  • Oversees accuracy and productivity of clinical staff in collaboration with the HEDIS Sr.
    Clinical Lead and Manager of Quality Measurement
  • Develops and implements the inter-rater reliability policy.
  • Develops and implements initiatives to strategically improve HEDIS projects processes
  • Ensures clinical HEDIS processes and outcomes comply with all NCQA standards and
    timelines.
  • Controls a subset of key HEDIS and HACCRD audit activity.
  • Ensures HACCRD activities meet targeted timelines
  • Develops and implements a monitoring strategy to ensure productivity of medical record
    reviewers and accuracy of data reporting.
  • Oversees contracted vendor’s accuracy and productivity in medical record abstraction in
    collaboration with the HEDIS Senior Clinical Lead and the Manager of Quality
    Measurement
  • Tracks all findings and issues relative to medical record review and escalate project risks
    to HEDIS leadership.
  • Participates in the development and review of policies and procedures related to the
    HEDIS project.
  • Identifies opportunities to educate providers through regulator patient safety activities to
    support improving HEDIS performance in collaboration with Quality Improvement
    Performance Improvement Clinical Specialists.
  • Leverages existing programs within QI, identifying opportunities to improve across key quality indicators within HEDIS.
  • Identifies opportunities to educate providers through regular patient safety activity to support improving HEDIS and HACCRD performance in collaboration in with Quality Improvement Performance Improvement Clinical Specialists.
  • Leverages existing programs within QI, identifying opportunities to improve across key quality indicators within HEDIS.
  • Other duties as assigned.

Qualifications

Education and Experience

 

Bachelor’s degree is required; Master’s degree in healthcare is strongly
preferred. Current CA RN license is required. Management experience
strongly preferred. Experience with HEDIS medical record review
strongly preferred.

 

Special Skills, Licenses and Certifications

Strong written and oral communication skills. Strong organization
skills to work on multiple projects simultaneously within established
time frames.

 

Performance Based Competencies

 

 

Ability to plan, implement, and report on quality management
responsibilities. Ability to train and mentor others, both one-on-one
and in larger group settings.

 

 

Work Environment And Physical Demands

More than 50% of work time is spent using a desktop computer. When
necessary, the ability to lift, carry or move manuals and reports
weighing up to 25 lbs. Valid California driver’s license and proof of
current automobile insurance compliant with PHC policy are required
to operate a vehicle and travel for company business. Ability to travel
as needed. Must be able to work in a fast paced environment and
maintain courtesy and composure when dealing with internal and
external customers. Ability to function effectively with frequent
interruptions and direction from multiple team members.

 

 

 

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

 

IMPORTANT DISCLAIMER NOTICE

 

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

 

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