Job Description

Position Title: Quality Improvement Specialist

Location: Remote- United States (Any time zone, willing to work EST hrs.)

Duration: 4 months.

Schedule : Mon Fri, 8am 5pm EST

PR: $18- $22-00/hr.

Job description

Job 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.

Job 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

Typical Day in the Role

The typical workday would consist of pulling charts out of EMR's and conducting member outreach.
This team member will make a significant impact on the volume of charts abstracted/ overread.
The primary focus of this role is EMR downloads. KPI is 75 chart downloads per day.

Job Requirements:

Education: Bachelor's Degree (Preferred) (Bachelor's degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.)
Licensure: LPN or RN preferred . (Valid state clinical license preferred (i.e.- LPN, RN, etc.)
Experience: Years of experience required: 2+ and Experience in HEDIS or NCQA or related topics preferred

Skills:

Medical Record retrieval/ validation
Microsoft Office
Medical Terminology

Job Tags

Work at office, Remote work

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