Quality Improvement Specialist (HEDIS)

Spectraforce Technologies; Raleigh (NC); Remote; USD 55,000 - 70,000; Full time

Job summary

A healthcare quality improvement firm is seeking a Quality Improvement Specialist (HEDIS) to support the development of quality projects. This remote position requires a bachelor's degree in nursing or a related field, experience with HEDIS, and strong clinical support skills. The role is vital for ensuring quality standards and improving healthcare outcomes through effective analysis and monitoring of care gap closures.

Qualifications

• Bachelor's degree or equivalent healthcare experience is required.
• Valid state clinical license preferred.
• Experience with HEDIS or NCQA preferred.
• Ability to process a minimum of 6 records per hour.

Responsibilities

• Train staff in continuous quality improvement methodologies.
• Provide clinical support for medical record abstraction.
• Monitor performance on quality indicators.
• Develop and implement quality performance improvement plans.

Skills

Clinical support skills

Quality improvement methodologies

Data analysis

Communication skills

Collaboration

Education

Bachelor's degree in Nursing, Healthcare, or Quality

High School diploma

Tools

Adobe Acrobat

Excel

QMRM

Job description

Position Title

Quality Improvement Specialist (HEDIS)

Work Location

Remote

Assignment Duration

6 months

Work Schedule

9 AM - 5 PM

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

The team is dedicated to supporting Fidelis NY in executing year-round HEDIS chart chases and record reviews. Our primary goal is to maximize care gap closure rates and drive improvements in quality scores across the board. Requesting additional team members to complement our current efforts and ensure SLA's are met.

• Open communication - transparent and respectful dialogue at all levels.
• Collaboration - working together to solve problems and share insights.
• Fast-paced execution - thriving in dynamic environments with agility.
• Independent ownership - each team member is empowered to take initiative and deliver results autonomously.

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.
• Perform other duties as assigned.
• Comply 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.
• Previous HEDIS experience, including provider outreach for chart chase and record review; proficiency with Adobe Acrobat; familiarity with medical terminology and clinical documentation standards.
• Proficiency with Excel, previous experience with QMRM.
• Ability to process a minimum of 6 records per hour and maintain all expected SLA's related to provider outreach and chart chase.
• Core responsibilities include reviewing medical records for completeness and accuracy; processing records for upload into appropriate systems; abstracting data to support HEDIS care gap closure.
• Education/Certification: Required: High School diploma. Preferred: (not listed).
• Licensure: Required: N/A. Preferred: (not listed).