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To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that Forbes ranked Premera among America’s 2023 Best Midsize Employers and America's 2023 Best Employers By State.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com.

The HEDIS Clinical Administrator II is critical to the company’s HEDIS® quality reporting and improvement activities and initiatives. In this position, you will work in collaboration with others as well as independently, facilitating HEDIS® medical record abstracting, based on HEDIS Technical Specifications released each year by NCQA, and documenting abstraction outcomes.

Accountabilities can also include HEDIS® Roadmap, HEDIS® projects and activities, development of process improvements, and collaboration with many functional areas of the company and other healthcare entities to achieve objectives and desired outcomes. A member of a team that initiates quality improvements for service to customers and providers complying with State, Federal and Accreditation requirements.

You will provide subject matter expertise in a role that includes leadership, management, and oversight of ongoing operational activities that directly support HEDIS data collection, analysis of results, and reporting.

This is a virtual/telecommuter position, working from home.

What you’ll do:

• Abstract paper and electronic medical records using HEDIS® technical specifications as they relate to Premera’s clinical quality initiatives. Document and report out provider trends found during abstraction.

• Implement activities that support specific quality projects and activities, along with health and process improvement strategies in collaboration with associates throughout the organization.

• Develop, implement, and maintain HEDIS® Program documentation, including work plans, status reports, policies, and procedures required to meet regulatory and HEDIS® reporting requirements.

• Conduct HEDIS reporting activities and interventions that support data collection, reporting, communication, analysis of data, and results for HEDIS® audit reporting.

• Participate in or lead the implementation of activities that support specific quality and HEDIS improvement projects, activities, and process improvement strategies in collaboration with associates throughout the organization and with individual providers.

• Quality Reporter/Web SME for entering and reviewing abstracted data across every measure for every line of business.

• Maintain positive relationships with provider groups, healthcare entities, team members, and other stakeholders.

What you’ll bring:

• High School Diploma or (2) years of experience in Healthcare Administration, Health Education, Nursing or a related field. (Required)

• (2) years of experience in health plan quality management and clinical performance improvement including HEDIS reporting. (Required)

• Clinical experience in a physician’s office, working with medical records, or HEDIS specific medical record abstraction. (Required)

• Extensive medical record retrieval and abstraction of HEDIS specific measures. (Strongly Preferred)

• Experience with measuring and reporting HEDIS or other performance or outcome data preferred.

• Bachelor’s Degree in Health Administration, Health Education, Nursing, or another related field preferred

• Strong knowledge of the Microsoft Suite, including Excel..

• Project management experience preferred.

• Advanced experience in developing and maintaining timelines, process flows, SmartSheet and OneNote.

What we offer

• Medical, vision and dental coverage
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)
• Wellness incentives, onsite services, a discount program and more
• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

National Salary Range:

National Plus Salary Range:

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.