Commonwealth Care Alliance · 1 day ago
HEDIS Network Analyst
Boston, MA
Full-time
Hybrid
Mid, Senior Level
$55K/yr - $82K/yr
5+ years expCommonwealth Care Alliance is focused on improving quality benchmarks and member outcomes in healthcare. The HEDIS Network Analyst will support the Network and Provider Contracting department by identifying underperforming providers and implementing improvement initiatives to enhance quality performance metrics.
Health CareHospitalMedical
Responsibilities
Conduct weekly tracking of Quality/ HEDIS metrics, specifically focused on Initiation and Engagement of Alcohol or Other Dependence Treatment (IET) and Follow-Up after Hospitalization for Mental Illness (FUH) data:
Work with BI, Quality, and BH teams to evaluate and build data sources delivering accurate performance data and reliable actionable data
Track performance trends on a weekly basis, evaluating member-specific and provider level details
Identify reasons for low and high performance; which providers are doing well and which are struggling? Which diagnosis setting is leading to the highest number of missed opportunities for a timely Initiation visit?
Identify which Network providers are excelling and which are underperforming
Design IET and FUH data formats that are user-friendly and can be shared with relevant Network Providers, including those with delegated arrangements
Review YTD claims files on a monthly/quarterly basis to identify errors and address accordingly with appropriate SMEs
Meet with select Providers and HHs to discuss IET and FUH performance and workshop improvement interventions with short term and long-term goals
Understand barriers and challenges providers are experiencing
Work with high performers to build a comprehensive list of tips and best practices that can be shared with lower performing entities and with CCA’s internal BH and Care Partnership teams
Determine regular cadence to check-in with lower performing HHs and Providers to get updates on their progress
Partner with CCA Clinical teams and programs to build a roll out initiatives aimed at leveraging Providers to improve Quality measures
Train and Education Provider Network on the measures
Organize trainings, working with Quality and Clinical teams to build reference documents and aggregate content for webinars; work with appropriate SMEs to ensure materials and trainings are modified for different Provider audiences
Qualification
Required
Bachelor's degree or equivalent experience within healthcare project management, HEDIS and STARs measures, population health, and the health plan space
5+ years of experience working within community-based health and/or managed care
Strong organizing skills and analytic capabilities
Demonstrated understanding of the duals programs and Network quality measures
Analytic mindset with the ability to work within larger data sets to identify trends and produce actionable recommendations
Proven experience and understanding of HEDIS and Health Plan quality initiatives; familiarity with behavioral health KPIs such as IET and FUH
Results oriented and self-motivated with the ability to work independently and collaboratively across internal and external stakeholders
Has the ability to thrive in high pressured environments, adjust to shifting priorities, and multi-task
Working knowledge of project/program management practices
Strong verbal communication skills with the ability to present data insights to various audiences, facilitate meetings and project plans
Proficiency with spreadsheets and databases, including excel, PowerPoint, and word
Team player with interest and ability to pivot as needed to meet the larger performance goals of the Network departments
English
Preferred
Master's degree within healthcare management and administration, public health, business administration or relevant field
Experience working within community-based health and/or health plan organization to lead Network projects, clinical implementation, and/or population health initiatives
Benefits
You may qualify for a bonus tied to company and individual performance.
We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Company
Commonwealth Care Alliance
Commonwealth Care Alliance is an integrated care system that advocates for economical healthcare policies.
1001-5000 employees
H1B Sponsorship
Commonwealth Care Alliance has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (16)
2023 (11)
2022 (18)
2021 (21)
2020 (15)
Funding
Current Stage
Late StageTotal Funding
$1.77MKey Investors
The Robert Wood Johnson Foundation
2025-04-09Acquired
2019-11-11Grant· $1.77M
Leadership Team
Amanda Cassel Kraft
Chief Operating Officer
Don Stiffler
Chief Revenue and Growth Officer
Recent News
2025-12-29
Press Telegram
2025-12-03
Company data provided by crunchbase