Clinical - Quality Improvement Specialist (HEDIS) - 112274 Job at Pacer Group, Remote

TkpRL1djaDE4VVVuZE9acVY3OWcxbXVUdnc9PQ==
  • Pacer Group
  • Remote

Job Description

Position Title: Quality Improvement Specialist

Location: Remote- United States (Any time zone, willing to work EST hrs.)

Duration: 4 months.

Schedule : Mon Fri, 8am 5pm EST

PR: $18- $22-00/hr.

Job description

Job 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.

Job 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

Typical Day in the Role

  • The typical workday would consist of pulling charts out of EMR's and conducting member outreach.
  • This team member will make a significant impact on the volume of charts abstracted/ overread.
  • The primary focus of this role is EMR downloads. KPI is 75 chart downloads per day.

Job Requirements:

  • Education: Bachelor's Degree (Preferred) (Bachelor's degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.)
  • Licensure: LPN or RN preferred . (Valid state clinical license preferred (i.e.- LPN, RN, etc.)
  • Experience: Years of experience required: 2+ and Experience in HEDIS or NCQA or related topics preferred

Skills:

  • Medical Record retrieval/ validation
  • Microsoft Office
  • Medical Terminology

Job Tags

Work at office, Remote work

Similar Jobs

Que Chido, LLC

BUSSER - MIJO MODERN MEXICAN Job at Que Chido, LLC

JOB REQUIREMENTS: To include but not limited to # Setting and resetting of tables before, during and after service periods with clean dishes, silverware and polished glassware. # Pouring waters, serving breads, condiments and some side-items as necessary. # Command...

Resilient Inc.

Customer Service Assistant - Entry Level Job at Resilient Inc.

 ...This is an entry-level opportunity with training provided . Youll learn how to...  ...is a great opportunity to gain hands-on experience in customer service, marketing, sales, and...  ...What We Offer Entry-level position Paid training Hands-on customer service and... 

Team Carney

Project Manager - Homeland Security Job at Team Carney

This Project Manager position supports the Department of Homeland Security (DHS), Customs and Border Protection (CBP) in the area of Support Services. The mission-critical program provides comprehensive training, safety, standards, curriculum development, and technical... 

Mathnasium

Math Instructor/Tutor Job at Mathnasium

 ...Mathnasium of Laurel, were passionate about both our students and our employees! We set ourselves apart by providing Math Instructor / Tutors with: A rewarding opportunity to transform the lives of 1st-12th grade students Consistent, but flexible part-time hours... 

Confidential

Open Enrollment Specialist Job at Confidential

 ...opportunity for individuals with healthcare, insurance, medical office, dental office, or medical billing experience who enjoy helping customers and solving complex...  ...Open Enrollment experience Medical billing and coding knowledge Insurance industry experience Call...