Clinical - Quality Improvement Specialist (HEDIS) - 112274

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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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?		2 temps needed to support year end push initiatives for hedis team to complete the year round measures specific projects needed to close gaps prior to the year end cutoff and then transition to supporting the hybrid project that includes 12 projects and medical record requests/reviews to increase star ratings across all the health plan lines of business.
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?			Medical record research, review, abstraction, fax projects, etc. Will collaborate and interact with the team daily.
Candidate Requirements
Education/Certification	Required: Bachelor s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.				Preferred:
Licensure	Required:				Preferred:
Years of experience required: NCQA experience with HEDIS gap closure. Disqualifiers: Additional qualities to look for: quality improvement, medical coding, data analytics, and compliance understanding
Top 3 must-have hard skills stack-ranked by importance			1	Knowledge of NCQA technical specifications and how to navigate and utilize them
			2	Medical Terminology skills
			3	Technical skills, excel, word and Microsoft office suite
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, phone, etc.
			Required Testing or Assessment (by Vendor):			Typing test, basic computers skills test, etc.
Next Steps
Do you have any upcoming PTO?			no
Colleagues to cc/delegate			Sara Potter will assist with hiring and training