Commonwealth Care Alliance
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Temporary, HEDIS Analyst
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Commonwealth Care Alliance 011230 CA-Provider Engagement & Performance This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time. Position Summary The HEDIS Network Analyst will support CCA’s ability to meet and surpass critical Quality benchmarks and optimize member outcomes as measured through key measures. The role supports efforts of the Network and Provider Contracting department and will have regular interaction with Clinical, Quality, and BI departments, while interfacing with Providers within CCA’s Network. The objective is to reduce or prevent revenue loss due to below-benchmark performance on critical Quality measures. Priority measures may shift annually based on organizational performance trends. This role’s three key focus areas will be: Identify underperforming Providers Work cross-functionally to determine expectations and solutions Facilitate and implement Provider-specific and/or Network improvement initiatives Current year priority measures include Initiation and Engagement of Alcohol or Other Dependence Treatment (IET) and Follow-Up after Hospitalization for Mental Illness (FUH). The ideal candidate will have strong organizational skills, analytical capabilities, and experience working with internal and external stakeholders to coordinate quality improvement projects. Supervision Exercised No, this position does not have direct reports. Essential Duties & Responsibilities Track weekly Quality/HEDIS metrics focused on IET and FUH data, working with BI, Quality, and BH teams to evaluate and build data sources, track trends, and identify performance issues. Design user-friendly data formats for sharing with Network Providers. Review claims files monthly/quarterly to identify errors and address them. Meet with Providers and HHs to discuss performance and develop improvement strategies. Partner with Clinical teams to develop initiatives to improve Quality measures. Train and educate Provider Network on measures, organize trainings, and develop reference materials. Working Conditions This is a remote role with standard operating hours of 8:30am-5pm, Monday-Friday. Member Facing ☒ NO: The job duties do not involve face-to-face contact with members. Required Education Bachelor’s degree or equivalent experience in healthcare project management, HEDIS and STARs measures, population health, or health plan space. Desired Education Master’s degree in healthcare management, public health, business administration, or relevant field. MA Health Enrollment No, this is not required. Required Experience 5+ years in community-based health and/or managed care. Desired Experience Experience leading Network projects, clinical implementation, or population health initiatives within community health or health plan organizations. Required Knowledge, Skills & Abilities Strong organizational and analytical skills Understanding of duals programs and Network quality measures Experience with HEDIS and health plan quality initiatives, familiarity with behavioral health KPIs Results-oriented, self-motivated, able to work independently and collaboratively Ability to thrive under pressure, adapt to shifting priorities, multitask Knowledge of project/program management practices Excellent verbal communication, presentation skills, proficiency with spreadsheets and databases Required Language English Seniority level
Mid-Senior level Employment type
Temporary Job function
Business Development and Sales Industries
Hospitals and Health Care This job is active and not expired.
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Temporary, HEDIS Analyst
role at
Commonwealth Care Alliance 011230 CA-Provider Engagement & Performance This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time. Position Summary The HEDIS Network Analyst will support CCA’s ability to meet and surpass critical Quality benchmarks and optimize member outcomes as measured through key measures. The role supports efforts of the Network and Provider Contracting department and will have regular interaction with Clinical, Quality, and BI departments, while interfacing with Providers within CCA’s Network. The objective is to reduce or prevent revenue loss due to below-benchmark performance on critical Quality measures. Priority measures may shift annually based on organizational performance trends. This role’s three key focus areas will be: Identify underperforming Providers Work cross-functionally to determine expectations and solutions Facilitate and implement Provider-specific and/or Network improvement initiatives Current year priority measures include Initiation and Engagement of Alcohol or Other Dependence Treatment (IET) and Follow-Up after Hospitalization for Mental Illness (FUH). The ideal candidate will have strong organizational skills, analytical capabilities, and experience working with internal and external stakeholders to coordinate quality improvement projects. Supervision Exercised No, this position does not have direct reports. Essential Duties & Responsibilities Track weekly Quality/HEDIS metrics focused on IET and FUH data, working with BI, Quality, and BH teams to evaluate and build data sources, track trends, and identify performance issues. Design user-friendly data formats for sharing with Network Providers. Review claims files monthly/quarterly to identify errors and address them. Meet with Providers and HHs to discuss performance and develop improvement strategies. Partner with Clinical teams to develop initiatives to improve Quality measures. Train and educate Provider Network on measures, organize trainings, and develop reference materials. Working Conditions This is a remote role with standard operating hours of 8:30am-5pm, Monday-Friday. Member Facing ☒ NO: The job duties do not involve face-to-face contact with members. Required Education Bachelor’s degree or equivalent experience in healthcare project management, HEDIS and STARs measures, population health, or health plan space. Desired Education Master’s degree in healthcare management, public health, business administration, or relevant field. MA Health Enrollment No, this is not required. Required Experience 5+ years in community-based health and/or managed care. Desired Experience Experience leading Network projects, clinical implementation, or population health initiatives within community health or health plan organizations. Required Knowledge, Skills & Abilities Strong organizational and analytical skills Understanding of duals programs and Network quality measures Experience with HEDIS and health plan quality initiatives, familiarity with behavioral health KPIs Results-oriented, self-motivated, able to work independently and collaboratively Ability to thrive under pressure, adapt to shifting priorities, multitask Knowledge of project/program management practices Excellent verbal communication, presentation skills, proficiency with spreadsheets and databases Required Language English Seniority level
Mid-Senior level Employment type
Temporary Job function
Business Development and Sales Industries
Hospitals and Health Care This job is active and not expired.
#J-18808-Ljbffr