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 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
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $7.25/hr - $80.00/hr.
