Remote HEDIS Quality Improvement Specialist (NCQA)

Spectraforce Technologies, Inc.; Raleigh (NC); Remote; USD 70,000 - 90,000; Full time

Job summary

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.

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

Skills

NCQA specs

Medical terminology

MS Office

Education

Bachelors degree in Nursing/Healthcare/Quality

Job description

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.