Quality Improvement Lead – HEDIS/NCQA Focus

Mercy Health Corporation; Janesville (WI); On-site; USD 39,000 - 61,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

Paid time off

Job summary

Mercyhealth seeks a Quality Initiatives Specialist to analyze clinical quality data, forecast performance, and present findings supporting NCQA standards and HEDIS measures. You will plan quality improvement projects, coordinate member/provider outreach, and facilitate referrals to disease and case management programs.

The role involves leading initiatives, monitoring outcomes, and assisting in training and data submission across medical records and HEDIS applications.

Qualifications

• Bachelor's degree in a related field or 5 years of related experience.
• Three years of experience in managed care or health care delivery systems.
• Experience with EPIC applications (Tapestry and Healthy Planets).
• Continuous Quality Improvement methodologies: data collection, management, analysis, and reporting.

Responsibilities

• Lead specialist for department initiatives and guidance.
• Monitor and analyze outcomes to meet requirements.
• Manage targeted disease populations using Access databases.
• Design strategies for outcomes improvement.
• Support continuous quality improvement activities and project follow-ups.
• Perform data abstraction and verify documentation against specifications.
• Coordinate and prepare HEDIS medical record reviews.
• Support accreditation activities and data reporting.

Skills

Priority management

Communication skills

Persistence

MS Office

Data warehousing basics

Data extraction tools

Education

Bachelor's degree in related field

3+ years managed care experience

CPHQ / RHIT preferred

Tools

EPIC (Tapestry/Healthy Planets)

Job description

Mercyhealth seeks a Quality Initiatives Specialist to analyze clinical quality data, forecast performance, and present findings supporting NCQA standards and HEDIS measures. You will plan quality improvement projects, coordinate member/provider outreach, and facilitate referrals to disease and case management programs.

The role involves leading initiatives, monitoring outcomes, and assisting in training and data submission across medical records and HEDIS applications.