HEDIS Specialist
Job Title: HEDIS Specialist Job Description Support the development and maintenance of quality improvement related projects specific to HEDIS Hybrid Operations. This role exists to support health plans in the clinical aspect of medical record review.
Responsibilities
- Train providers, health plans, and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes.
- Provide clinical support to the medical record abstraction, over-read, and audit processes.
- Monitor performance on established contractual quality indicators.
- Analyze, track, and trend results.
- Prepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholders.
- Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model.
- Monitor and report PIPs progress through closure.
- Perform other duties as assigned. Essential Skills
- Proficiency in quality improvement and medical terminology.
- Experience with HEDIS and NCQA.
- Strong skills in medical record review and data entry.
- Experience in healthcare environments Additional Skills & Qualifications
- Bachelor's degree in Nursing, Healthcare, or Quality, including HEDIS measures or NCQA, or equivalent experience in related healthcare fields.
- Valid state clinical license preferred (e.g., LPN, RN).
- Experience in HEDIS, NCQA, or related topics is preferred.
Work Environment
This position is 100% remote, allowing flexibility and the comfort of working from home. Job Type & Location This is a Contract position based out of Cleveland, OH. Pay and Benefits The pay range for this position is $19.00 - $20.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 29, 2025. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [email protected] for other accommodation options. Apply tot his job
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