Position Details Position Title: Quality Improvement Specialist (HEDIS)
Work Location: Remote - Arkansas
Assignment Duration: 3 Months
Work Schedule: 8-5 CST
Work Arrangement: Remote-Arkansas
Position Summary 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.
Background & Context Arkansas Quality Team needs staff to assist with End of Year Push projects to increase gap closure rates. This will include medical record retrieval and abstraction among other quality interventions.
Key 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
Qualification & Experience 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 (i.e. LPN, RN, etc.)
Experience in HEDIS or NCQA or related topics preferred
Must haves: NCQA experience with HEDIS gap closure.
Nice to haves: quality improvement, medical coding, data analytics, and compliance understanding
Performance indicators: Knowledge of NCQA technical specifications and how to navigate and utilize them
Medical Terminology skills
Technical skills, Excel, Word and Microsoft Office Suite