HEDIS Specialist

Position Purpose: Supervise and facilitate successful interventions to meet behavioral health HEDIS and Pay for Performance measures. Partner with health plans and regional clinical leadership to identify and implement interventions to increase HEDIS rates in behavioral health measures.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

The ideal candidate will have demonstrated experience improving HEDIS Hybrid measures, including identifying and closing care gaps, implementing targeted interventions, and partnering with health plan and clinical leadership to improve HEDIS measures.

• Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures

• Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources

• Act as a liasion with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes

• Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures

• Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Bachelor’s degree in nursing, related field, or equivalent experience. 3+ years of experience in case and/or utilization management in a behavioral health or physical health care setting. Knowledge of key behavioral or physical health related HEDIS & performance measures required with preferred experience in implementing new interventions to affect these rates. Supervisory or lead experience preferred.

License/Certificates: Current state’s unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN preferred

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Originally posted on Himalayas