Remote Clinical Quality RN - HEDIS & CQI Specialist

wvumedicine; United States; Remote; USD 70.000 - 100.000; Vollzeit

Zusammenfassung

PHH Peak Health Holdings is seeking a Clinical Quality Specialist to support performance improvement initiatives, oversee HEDIS activities, and ensure regulatory compliance. The role emphasizes data-driven evaluation, chart abstraction, and collaboration with the Quality Manager to drive quality outcomes.

The position requires an RN license (or eNLC) and several years of healthcare quality experience, with knowledge of CMS guidelines and NCQA/HEDIS standards.

Qualifikationen

• Active RN license in the state where services will be provided or multi-state RN via eNLC.
• 4 years of healthcare clinical experience.
• Bachelor's degree in healthcare or related field plus 6 years quality management/PI experience.
• Knowledge of CMS guidelines, NCQA and HEDIS/Stars.

Aufgaben

• Plan, design, implement, and maintain a CQI program through HEDIS tracking and analysis.
• Lead HEDIS/Stars improvement activities including medical record review and member/provider interventions.
• Prepare annual QI evaluation reports and program documents.
• Review medical records to ensure quality care is provided.
• Ensure compliance with workflows, policies, and accreditation standards.
• Investigate quality of care issues affecting member health and safety.
• Participate in quality committee and develop annual work plans and evaluations.

Kenntnisse

CMS regulations

HEDIS/Stars knowledge

Quality improvement

Data analysis

Ausbildung

RN license

Bachelor's degree in healthcare

Tools

Microsoft Office

Jobbeschreibung

PHH Peak Health Holdings is seeking a Clinical Quality Specialist to support performance improvement initiatives, oversee HEDIS activities, and ensure regulatory compliance. The role emphasizes data-driven evaluation, chart abstraction, and collaboration with the Quality Manager to drive quality outcomes.

The position requires an RN license (or eNLC) and several years of healthcare quality experience, with knowledge of CMS guidelines and NCQA/HEDIS standards.