Clinical - Quality Improvement Specialist (HEDIS) - 112274

Mindlance; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare consulting firm in the United States seeks a quality improvement professional to support HEDIS Hybrid Operations. The role involves training healthcare staff, monitoring quality indicators, and providing clinical support. Applicants should possess a Bachelor’s degree in a related field and preferably have experience with HEDIS or NCQA. A valid state clinical license is preferred. This position offers an opportunity to contribute to healthcare quality improvements within a supportive environment.

Qualifications

• Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience.
• Valid state clinical license preferred (LPN, RN, etc.).
• Experience in HEDIS, NCQA or related topics preferred.

Responsibilities

• Train providers and health plans in quality improvement methodologies.
• Provide clinical support for medical record abstraction and audits.
• Monitor performance on established quality indicators.
• Prepare for meetings with committees and stakeholders.

Skills

Quality improvement methodologies

HEDIS measures

Clinical support

Education

Bachelor’s degree in Nursing, Healthcare, or Quality

Job description

Overview

Job Profile Summary

Position Purpose: 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.

Education/Experience

Education/Experience: Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.

License/Certification

License/Certification: Valid state clinical license preferred (i.e.- LPN, RN, etc.).

Experience

Experience: Experience in HEDIS or NCQA or related topics preferred.

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.

EEO

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”