Clinical - Quality Improvement Specialist (HEDIS) - 112274

Disqualifiers: Additional qualities to look for: Strong communication skills, Can-do attitude, fast learner, positive attitude, experience reviewing medical records, attention to detail Top 3 must-have hard skills stack-ranked by importance. Education/Experience: Bachelor s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.

Job Profile Summary
Position Purpose:
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.

Education/Experience:
Bachelor s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.

License/Certification:
Valid state clinical license preferred (i.e.- LPN, RN, etc.)

Experience:
Experience in HEDIS or NCQA or related topics preferred

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

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Job Profile Summary Position Purpose: 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. Education/Experience: Bachelor s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience. License/Certification: Valid state clinical license preferred (i.e.- LPN, RN, etc.) Experience: Experience in HEDIS or NCQA or related topics preferred 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
Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		This employee will help with HEDIS Operations and medical record retrieval. The purpose of our team is to drive care gap closure, and help support initiatives that provide better outcomes for our members. Our team culture is collaborative, and seasoned. We encourage each other and communicate kindly and effective with each other. The team relies on teams messages to support each other. We do team huddles and collaboration calls. Key Projects will be pulling EMR records for Year Round HEDIS Ops.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?			The typical workday would consist of pulling charts out of EMR s and conducting member outreach. This team member will make a significant impact on the volume of charts abstracted/ overread. The primary focus of this role is EMR downloads. KPI is 75 chart downloads per day.
Candidate Requirements
Education/Certification	Required:				Preferred: Bachelor s Degree
Licensure	Required:				Preferred: LPN or RN
Years of experience required: 2+ Disqualifiers: Additional qualities to look for: Strong communication skills, Can-do attitude, fast learner, positive attitude, experience reviewing medical records, attention to detail
Top 3 must-have hard skills stack-ranked by importance			1	Medical Record retrieval/ validation
			2	Microsoft Office
			3	Medical Terminology
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations			Projected Manager Candidate Review Date:			1-2 days post shortlisting
			Type of Interviews:			Teams- On Camera
			Required Testing or Assessment (by Vendor):			N/A