Position Title: Quality Improvement Specialist (HEDIS)
Work Location: Remote
Assignment Duration: 6 months
Work Schedule: 8-5 CST Mon-Fri No OT and holiday
Work Arrangement: Remote
Position Summary:
Support the development and maintenance of quality improvement related projects specific to HEDIS Hybrid Operations. The position exists to support the health plans in the clinical aspect of medical record review.
Key Responsibilities
- Train providers, health plans and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes
- Provide clinical support to the medical record abstraction, over-read and audit processes
- Monitor performance on established contractual quality indicators.
- Analyze, track and trend results
- Prepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholders
- Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model.
- Monitor and report PIPs progress through closure.
- Performs other duties as assigned
- Complies with all policies and standards
Candidate Requirements
Education/Certification
Required: Bachelor's degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.
Preferred:
Licensure
Required:
Preferred:
Years of Experience Required
NCQA experience with HEDIS gap closure.
Additional qualities to look for: quality improvement, medical coding, data analytics, and compliance understanding.
Top 3 must-have hard skills stack-ranked by importance
- 1. Knowledge of NCQA technical specifications and how to navigate and utilize them
- 2. Medical Terminology skills
- 3. Technical skills, excel, word and Microsoft office suite
Quality Improvement Specialist (HEDIS) in raleigh at Unknown Company
This position is listed as contract and able to be worked remotely.