Quality Improvement Specialist (HEDIS)

Summary:

• Support the development and maintenance of quality improvement projects specific to HEDIS Hybrid Operations.
• Assist health plans in the clinical aspect of medical record review.

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.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements:

• Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.
• Valid state clinical license preferred (e.g., LPN, RN).

Preferred Skills:

• Experience in HEDIS or NCQA or related topics preferred.