About this role
Coordinate and monitor quality improvement and organizational projects from inception to closure, with a strong focus on NCQA and HEDIS preparation. The role drives education, work planning, data validation, interventions, and project deliverables to improve HEDIS/CAHPS performance.
Key Responsibilities
- Provide NCQA/HEDIS knowledge and deliver educational sessions
- Coordinate HEDIS/CAHPS work plans and submissions to Connector Authority and NCQA
- Run data review processes to ensure data accuracy and integrity
- Coordinate interventions to increase HEDIS, CAHPS, and designated health measures
- Manage project lifecycle, deliverables, documentation, and support HEDIS audit activities
Technical Overview
Operationalizes NCQA/HEDIS readiness by managing data pulls, running a data review process to ensure accuracy and integrity, and supporting the HEDIS audit process. Uses project life cycle management practices and maintains detailed documentation (minutes, action items, issues, and risk management plans) while producing presentations and educational materials.
Ideal Candidate
The ideal candidate is a quality improvement and project management professional with 4+ years of experience in managed care and advanced knowledge of HEDIS and NCQA. They can coordinate NCQA/HEDIS readiness through rigorous data review for accuracy and integrity, develop and run interventions to improve HEDIS/CAHPS measures, and manage project life cycles using strong Microsoft Excel, PowerPoint, and Access proficiency.
Must-Have Skills
4+ years of quality improvement or project management experience in managed careadvanced knowledge of HEDISadvanced knowledge of NCQAProficiency required in Microsoft applications including PowerPointExcel and Access
Nice-to-Have Skills
Master's in Public Health or related field
Tools & Platforms
Microsoft PowerPointMicrosoft ExcelMicrosoft Access
Required Skills
Quality improvement (QI) project managementNCQA preparationHEDIS preparationHEDIS data review processdata accuracydata integrityinterventions for HEDISinterventions for CAHPSNCQA standardsNCQA accreditation maintenanceproject deliverables monitoringdesign documentstest plansoperations documentationrequirements gatheringproject plans and schedulesresource managementHEDIS audit process supportdata pullsdata managementrisk management plansMicrosoft PowerPointMicrosoft ExcelMicrosoft AccessPowerPointExcelAccesscommittee presentations
Hard Skills
quality improvement (QI) project managementorganizational projects from inception to closureNational Committee for Quality Assurance (NCQA) preparationHealthcare Effectiveness Data and Information Set (HEDIS) preparationHEDIS data review processdata accuracy and integrity validationinterventions to increase HEDIS measuresinterventions to increase CAHPS measuresNCQA standards adherencemaintaining NCQA accreditationrequirements gatheringproject plan and schedule creationresource managementHEDIS audit process supportproject executiondeployment and closuredata pulls and ongoing data managementHEDIS and QI project management databasesalternative data capture evaluationmethodology assessment and results evaluationproject deliverables creation monitoringdesign documentstest plansoperations documentationproject documentation (meeting minutesaction itemsissues listsrisk management plans)Microsoft PowerPointMicrosoft ExcelMicrosoft AccessMicrosoft applications
Soft Skills
educational session deliverycross-functional coordinationpresentations and communicationstakeholder managementcommittee communicationdocumentation discipline
Keywords for Your Resume
Quality Improvement Project ManagerQuality ImprovementProject ManagerHealth EquityNational Committee for Quality Assurance (NCQA)NCQAHealthcare Effectiveness Data and Information Set (HEDIS)HEDISCAHPSConsumer Assessment of Healthcare Providers and SystemsConnector Authoritywork plandata review processdata accuracydata integrityinterventionsHEDIS auditNCQA accreditationmanaged careproject life cyclerequirements gatheringproject plans and schedulesresource managementdata pullsdata managementrisk management plansMicrosoft PowerPointMicrosoft ExcelMicrosoft AccessPowerPointExcelAccess
Deal Breakers
4+ years of quality improvement or project management experience in managed care, Advanced knowledge of HEDIS and NCQA, Required proficiency in Microsoft applications including PowerPoint, Excel and Access
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