Sign upLog in

Quality Improvement Specialist (HEDIS) - 112274

IMCS Group Inc

Various, KY

Apply
JOB DETAILS
SKILLS
Analysis Skills, Clinical Competency, Clinical Support, Health Plan, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Providers, Healthcare Quality, Licensed Practical Nurse/Licensed Vocational Nurse, Medical Records, National Committee for Quality Assurance (NCQA), Nursing, Performance Analysis, Performance Management, Progress Reports, Quality Management, Trend Analysis, Vendor/Supplier Planning
LOCATION
Various, KY
POSTED
3 days ago
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: Shortlisting Date
Value: None

Name: Contract Type
Value: Contract Only

Name: Which Health Plan, programs or functions will this work support?
Value: WellCare of KY

Name: Field Worker
Value: No

Name: Working in *** Facility or Worksite
Value: No

About the Company

I

IMCS Group Inc