Quality Improvement Specialist (HEDIS)

Position Title : Quality Improvement Specialist (HEDIS)

Work Location : Remote

Assignment Duration : 6 months

Work Schedule : 9 Am- 5 PM

Work Arrangement : Remote

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 :

The team is dedicated to supporting Fidelis NY in executing year-round HEDIS chart chases and record reviews. Our primary goal is to maximize care gap closure rates and drive improvements in quality scores across the board. Requesting additional team members to complement our current efforts and ensure SLA's are met.

We foster a team culture built on :

Open communication - transparent and respectful dialogue at all levels.

Collaboration - working together to solve problems and share insights.

Fast-paced execution - thriving in dynamic environments with agility.

Independent ownership - each team member is empowered to take initiative and deliver results autonomously.

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 : Previous HEDIS experience, including provider outreach for chart chase and record review; proficiency with Adobe Acrobat; Familiarity with medical terminology and clinical documentation standards.

Nice to haves : Proficiency with Excel, previous experience with QMRM

Performance indicators : Ability to process a minimum of 6 records per hour and maintain all expected SLA's related to provider outreach and chart chase.

Core responsibilities include : Reviewing medical records for completeness and accuracy; Processing records for upload into appropriate systems; Abstracting data to support HEDIS care gap closure.

Education / Certification : Required : High School diploma. Preferred : (not listed)

Licensure : Required : N / A. Preferred : (not listed)