Quality Improvement Specialist (HEDIS)

Position Title : Quality Improvement Specialist (HEDIS)

Work Location : Remote - Kentucky

Assignment Duration : 6 months

Work Schedule : Standard 8-hour workday starting at 8 : 00 AM EST and ending between 4 : 30-5 : 00 PM EST, depending on 0.5-1-hour lunch break

Work Arrangement : Remote

Position Summary :

• Supporting Wellcare of KY Improvement department and the HEDIS Operations team.
• These positions join a team comprised of abstractors and over readers, with a primary goal of identifying services to close quality measure gaps.
• This assignment is to support the existing team in constructing and managing Q4 initiatives to improve performance and to carry out the annual HEDIS hybrid chart chase project.
• Regular communication and collaboration with permanent staff on a scheduled and ad-hoc basis will be required.
• Comfortability with outbound phone calls is required for this role.

Qualification & Experience :

Required : Bachelor's Degree in Nursing, Healthcare, or Quality

Preferred : N / A

Required : N / A

Preferred : RN, BSN, LPN

Must have : Experience with HEDIS programs or NCQA-related topics, Microsoft Excel proficiency

Nice to have : Experience with HEDIS medical record abstraction preferred

Disqualifiers : No Quality Improvement experience

Top 3 Must-Have Hard Skills (Stack Ranked) :

Microsoft Excel - Beginner to Intermediate (Sort, Filter, Format, Basic Visualizations, Simple Formulas)

Medical Record Abstraction (Quality HEDIS) - Beginner to Intermediate

Database Management / Standardized Data Entry - Intermediate

Candidate Requirements

Education / Certification

Required : Required : Bachelor's Degree Nursing, Healthcare, Quality

Preferred : N / A

Licensure

Required : N / A

Preferred : RN, BSN, LPN

Years of experience required :

Must have : Experience with HEDIS programs or NCQA related topics, Microsoft Excel proficiency

Nice to have : Experience with HEDIS medical record abstraction preferred

Disqualifiers : No Quality Improvement experience

Performance indicators : Average daily productivity metrics outlined for record requests sent, records processed for intake, abstractions completed, or other duties assigned - to mirror permanent staff.

Microsoft Excel - Beginner to Intermediate (Sort, Filter, Format, Basic Visualizations, Simple Formulas)

Medical record abstraction (Quality HEDIS) - Beginner to Intermediate

Database Management / Standardized Data Entry - Intermediate