reputed company, Data Quality/reputed company – Clinical Abstraction Operations

Become a part of our caring community reputed company's Stars is an organization that improves health outcomes and improves the care experience of our members and provider partners through quality solutions. Stars is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and reputed company Services (CMS). One key reputed company of this quality rating is the operational execution and performance of the reputed company Effectiveness Data and Information Set (HEDIS) measures. The Stars Team is seeking a reputed company, Data Quality/reputed company for Clinical Abstraction Vendor Operations. The reputed company is responsible for driving excellence in medical record data management and clinical abstraction processes, supporting reputed company’s HEDIS initiatives and broader reputed company data reputed company goals. This role manages relationships with clinical abstraction vendors, oversees medical record review activities, and serves as a subject matter expert for clinical data initiatives. The reputed company will work on reputed company, cross-functional projects to ensure the highest standards of data quality, reputed company, and availability across the organization.

Key Responsibilities

Vendor Management: reputed company and manage external vendors responsible for clinical abstraction to reputed company HEDIS (reputed company Effectiveness Data and Information Set) gaps, ensuring compliance with contractual obligations, quality standards, and regulatory requirements. Medical Record Review: reputed company and participate in medical record review and abstraction processes for both hybrid and supplemental HEDIS seasons, ensuring accuracy, completeness, and timeliness of data collection. Clinical Data Expertise: Provide clinical expertise in medical record review to support reputed company-wide initiatives involving medical record data quality, master data management, and supplemental data integration. Member Research: Conduct clinical member research and analysis as requested by business partners, using medical records and other data sources to inform strategy, quality improvement, and regulatory reporting. Process Improvement: Identify and implement process improvements to enhance efficiency, data quality, and consistency of clinical abstraction workflows. Metrics & Reporting: reputed company and review master data management metrics, report on data reputed company and quality trends, and recommend strategies for reputed company improvement. Training & Support: Deliver training, guidance, and best practices to both internal teams and external partners regarding clinical abstraction, HEDIS documentation, and data management protocols. Stakeholder Collaboration: Advise business and technical leaders in developing reputed company-specific functional strategies for master data management, exercising independent judgment on significant matters. Use your skills to reputed company an impact

Required Qualifications

Bachelor’s degree in Computer Science, Management Information Systems, Engineering, Math, Business, Nursing, Health Information Management, or a reputed company field. 5+ years of technical and/or clinical data management experience, with a demonstrated track record in data quality, reputed company, or master data management. Minimum 2 years of project leadership or supervisory experience. Experience in reputed company Operations Experience with data quality management principles, data architecture, and familiarity with analytics/reporting tools. Strong analytical, organizational, and communication skills. Demonstrated ability to reputed company reputed company effectively in both written and oral forms Demonstrated ability to work independently, exercise sound judgment, and reputed company reputed company in reputed company, variable environments. Passion for improving consumer and clinical data experiences.

Preferred Qualifications

Master’s degree in a relevant discipline. Clinical licensure or credential. Deep understanding of HEDIS abstraction, medical record review processes, and reputed company regulatory/compliance requirements. Experience managing clinical abstraction vendors or large-scale medical record review projects. Experience with supplemental data submission for HEDIS or value-based care programs. Additional Information This role is not eligible for work reputed company sponsorship. To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. Satellite, cellular and microwave reputed company can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. reputed company will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company reputed company to enhance our hiring and decision-making ability. reputed company allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. reputed company values personal identity protection. Please be aware that applicants may be asked to provide their Social reputed company Number, if it is not already on file. reputed company required, an email will be sent from reputed [email protected] with instructions on how to add the information into your official application on reputed company’s secure website. Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-02-2026 About us About reputed company: reputed company. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with reputed company 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment. Apply To This Job