Quality Improvement Specialist (HEDIS)

Position Title: Quality Improvement Specialist (HEDIS)

Work Location: Remote - United States (any timezone, willing to work EST hours)

Assignment Duration: 4 months

Work Schedule: M-F; 8-5 EST

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.

Background & Context:

This employee will help with HEDIS Operations and medical record retrieval. The purpose of our team is to drive care gap closure, and help support initiatives that provide better outcomes for our members. Our team culture is collaborative, and seasoned. We encourage each other and communicate kindly and effective with each other. The team relies on teams messages to support each other. We do team huddles and collaboration calls. Key Projects will be pulling EMR records for Year Round HEDIS Ops.

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

Qualification & Experience:

* Bachelor's degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience. * Valid state clinical license preferred (i.e.- LPN, RN, etc.)

* Experience in HEDIS or NCQA or related topics preferred * Years of experience required: 2+ * Preferred: Bachelor's Degree

* Preferred: LPN or RN * Top 3 must-have hard skills: 1 Medical Record retrieval/ validation 2 Microsoft Office 3 Medical Terminology * Additional qualities to look for: Strong communication skills, Can-do attitude, fast learner, positive attitude, experience reviewing medical records, attention to detail