Quality Improvement Specialist (HEDIS)

Spectraforce Technologies, Inc.; Raleigh (NC); À distance; USD 70 000 - 90 000; Plein temps

Résumé du poste

Spectraforce Technologies, Inc. is seeking a Quality Improvement Specialist (HEDIS) for a remote, 6-month assignment. You will support development and maintenance of quality improvement projects and assist in the clinical aspects of medical record review for health plans.

Responsibilities include training providers and staff in QI methodologies, performing data analysis, monitoring indicators, and contributing to PIPs using PDSA cycles. Bachelor’s degree required; NCQA/HEDIS experience preferred.

Qualifications

• Bachelors degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent healthcare experience.
• NCQA/HEDIS knowledge and experience with quality improvement processes.
• Experience with data analytics, compliance, and medical coding is a plus.

Responsabilités

• 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

Connaissances

NCQA specs

Medical terminology

MS Office

Formation

Bachelors degree in Nursing/Healthcare/Quality

Description du poste

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