Overview
Remote
On-site
Job 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 EEO: Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans. ======================
| 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 preferredResponsibilitiesTrain providers, health plans and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processesProvide clinical support to the medical record abstraction, over-read and audit processesMonitor performance on established contractual quality indicators.Analyze, track and trend resultsPrepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholdersRecommend, 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 assignedComplies with all policies and standards | ||||||
| Story Behind the Need | ||||||
| 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 | ||||||
| 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 | ||||||
| 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 | ||||||
| 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 | ||||||
| no | |||||
| Sara Potter will assist with hiring and training | |||||
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FAQs About Clinical - Quality Improvement Specialist (Hedis) - 112274 Jobs at Mindlance
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