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Position Title: Quality Improvement Specialist (HEDIS)
Work Location: Remote-Arkansas (Can source nationwide)
Assignment Duration: 6 months
Work Schedule: 8-5 CST Mon - Fri No OT and holiday
Work Arrangement: Remote Position Summary:
- Support the development and maintenance of quality improvement related projects specific to HEDIS Hybrid Operations. The position exists to support the health plans in the clinical aspect of medical record review.
- Background & Context: Needed to support year end push initiatives for HEDIS team - to complete the year round measures specific projects needed to close gaps prior to the year end cutoff and then transition to supporting the hybrid project that includes 12 projects and medical record requests/reviews to increase star ratings across all the health plan lines of business.
Key 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.
- Performs other duties as assigned
- Complies with all policies and standards
Qualification & Experience:
- Bachelor's degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.
- Valid state clinical license preferred (i.e.- LPN, RN, etc.)
- Experience in HEDIS or NCQA or related topics preferred
- NCQA experience with HEDIS gap closure.
- Additional qualities: quality improvement, medical coding, data analytics, and compliance understanding
- Top hard skills: Knowledge of NCQA technical specifications and how to navigate and utilize them; Medical Terminology skills; Technical skills, excel, word and Microsoft office suite
| Candidate Requirements |
| Education/Certification |
Required: Bachelor's degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience. |
Preferred: |
| Licensure |
Required: |
Preferred: |
Years of experience required: NCQA experience with HEDIS gap closure.
Disqualifiers:
Additional qualities to look for: quality improvement, medical coding, data analytics, and compliance understanding |
- Top 3 must-have hard skills stack-ranked by importance
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1 |
Knowledge of NCQA technical specifications and how to navigate and utilize them |
| 2 |
Medical Terminology skills |
| 3 |
Technical skills, excel, word and Microsoft office suite |
| Candidate Review & Selection |
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
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Projected Manager Candidate Review Date: |
1-2 days post shortlisting |
Type of Interviews:
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Teams, phone, etc. |
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Spectraforce Technologies
Nov 13, 2026