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UPMC Health Plan has an exciting opportunity for a Sr. HEDIS Coordinator position in the Quality Improvement department. This is a full time position working Monday through Friday daylight hours and will be a remote position. Must be located in Pittsburgh or surrounding area to be considered!

The Sr. HEDIS Coordinator will assists with the management of HEDIS Coordinator activities in addition to performing the day-to-day functions of a HEDIS Coordinator. Supports various functions within the scope of the Health Plan?s Quality Improvement Program, working both independently and as a team member. The functions include but are not limited to Novillus Care Gap Management Application (CGMA) support, participation in data abstraction for the Health Plan Effectiveness Data and Information Set (HEDIS) program, committee support, an independent or collaborative quality project and the continual advancement of the quality improvement process to achieve the Health Plan?s goal of excellence.

Responsibilities:

+ Perform duties and responsibilities in accordance with the philosophy, standards and policies and procedures of the UPMC Health System, including conveying courtesy, respect, enthusiasm, and a positive attitude through all contacts with staff, health plan members, providers, peers, and visitors.

+ Perform in accordance with system-wide competencies/behaviors.

+ Complete a department identified quality improvement project under the supervision of Manager, i.e., development of HEDIS measure Tip Sheet(s), assist with Quality metric education for a UPMC Residency Program, etc. to facilitate process improvement and/or outcomes.

+ Participate in the Health Plan Effectiveness Data and Information Set (HEDIS) program including data abstraction and overread activities.

+ Participate in committee or work group activities, which may include completion of follow-up assignments, taking minutes or meeting facilitation. Complete delegated activities and project work within established time parameters.

+ Support Manager with analysis of CGMA user rejections and identification of educational opportunities.

+ Coordinate and conduct education for CGMA users as needed.

+ Assist with weekend CGMA testing as needed.

+ Adhere to the UPMC Health Plan HIPAA Compliance Guidelines.

+ Ensure that HIPAA standards are met in all aspects of the Department functions including delegated functions.

+ Ensure that all releases of member personal health information, which are conducted outside of the realm of Treatment, Payment, or Operations are appropriately logged.

+ Registered nurse with BSN.

+ Minimum of 2 years experience working as a HEDIS Coordinator.

+ Performance level maintained at Solid/Strong/Good or above while in this position.

+ Ability to work independently and as a productive team member.

+ Excellent verbal, written and presentation skills.

+ Excellent organizational and time management skills.

+ Demonstrated professionalism and self-motivation skills.

+ Solid knowledge of NCQA HEDIS Specifications.

+ Proficiency in Microsoft Word, PowerPoint and Excel preferred.Licensure, Certifications, and Clearances:UPMC is an Equal Opportunity Employer/Disability/Veteran