What are the responsibilities and job description for the Quality Practice Advisor position at Sunshine State Health Plan?
Job Title: HEDIS Quality Improvement Specialist
About Us:
We're a national organization transforming the health of our communities, one person at a time. As a diversified company, you'll have access to competitive benefits and a fresh perspective on workplace flexibility.
Key Responsibilities:
- Deliver education and support to large physician practices, IPAs, and providers regarding NCQA HEDIS measures, risk adjustment, and medical record documentation guidelines.
- Collect, summarize, and analyze provider quality and risk adjustment performance data to identify areas for improvement.
- Collaborate with Provider Relations and other teams to enhance provider performance in Quality, Risk Adjustment, and Operations.
- Develop and maintain strong clinical relationships with providers across product lines.
- Maintain high-quality KPIs and ensure accurate HEDIS abstraction rates.
Requirements:
- Bachelor's Degree or equivalent required.
- 3 years of experience in HEDIS record collection and risk adjustment (coding) required.
- One of the following certifications is required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS.
What We Offer:
- Competitive pay: $26.50 - $47.59 per hour.
- A comprehensive benefits package including health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, and flexible work arrangements.
Diversity and Inclusion:
We're an equal opportunity employer that values diversity and inclusion. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.
Salary : $27 - $48
