Remote Clinical Quality Improvement Lead
IntelliResume
Stand out for this role — generate a tailored resume and cover letter in about a minute.
Benefits offered by this job
Job summary
AmeriHealth Caritas North Carolina is seeking a Clinical Quality Performance Specialist in Raleigh, NC. You will lead the clinical quality review of member concerns and medical records, perform care reviews, and ensure timely collection of records for evaluation.
The role emphasizes quality improvement practice with RN input, QAPI coordination, and annual policy adherence in a full-time, hybrid work arrangement.
Qualifications
- Minimum 3 years in clinical or service quality improvement or healthcare delivery.
- Strong maternal and/or women’s health clinical practice experience desired.
Responsibilities
- Lead and coordinate the clinical quality review of member concerns and medical records.
- Perform quality of care reviews for sentinel events and member concerns.
- Assure collection and organization of minimally necessary medical records.
- Summarize clinical findings for review by clinical committees.
- Assist with QAPI meeting packets and schedules.
- Review and approve the quality management work plan annually.
- Develop quarterly trending reports for QAPI and follow up on recommendations.
- Adhere to quality management policies including annual reviews and updates.
- Support annual medical record review activities including HEDIS and NCQA.
Skills
Education
Job description
AmeriHealth Caritas North Carolina is seeking a Clinical Quality Performance Specialist in Raleigh, NC. You will lead the clinical quality review of member concerns and medical records, perform care reviews, and ensure timely collection of records for evaluation.
The role emphasizes quality improvement practice with RN input, QAPI coordination, and annual policy adherence in a full-time, hybrid work arrangement.
'/%3e%3cpath%20d='M101.744%2012.4726L102.894%2016.1947L99.0021%2013.2201L101.744%2012.4726ZM105.3%208.40937H100.488L99.0026%203.59473L97.5116%208.41047L92.7%208.40385L96.5965%2011.3834L95.1055%2016.1942L99.0021%2013.2196L101.408%2011.3834L105.3%208.40992V8.40937Z'%20fill='white'/%3e%3cdefs%3e%3clinearGradient%20id='paint0_linear_5593_1381'%20x1='90'%20y1='9.44471'%20x2='99'%20y2='9.44471'%20gradientUnits='userSpaceOnUse'%3e%3cstop%20stop-color='%2300AD70'/%3e%3cstop%20offset='0.998594'%20stop-color='%2300B67A'/%3e%3cstop%20offset='1'%20stop-color='%23DCDCE6'/%3e%3c/linearGradient%3e%3c/defs%3e%3c/svg%3e){kind=small}
