Description: 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
Custom Fields:
Name: Which Health Plan, programs or functions will this work support?
Value: WellCare of KY
Name: If this request is replacing a previously canceled request, please provide the original Request ID
Value: None
Name: Field Worker
Value: No
Name: Shortlisting Date
Value: None