Clinical Quality Research Analyst (HEDIS Registered Nurse)

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Job Summary

This position is responsible for conducting data collection and abstraction of medical records for HEDIS and quality projects including supplemental data collection. Responsible for interacting with various internal staff, internal departments, and network providers/IPAs to ensure quality performance and results for blue cross managed care products. Responsible for auditing all aspects of BCBSIL clinical quality improvement projects and evaluating PCP/MG/IPA compliance with BCBSIL clinical practice guidelines. Also responsible for data analysis, interaction with providers’ practices and IPAs to educate on HEDIS measures, gaps in care and quality programs. Translate data into actionable information and determine areas for improvements as well as help implement actions toward improvement and report results to internal and external customers.

Required Job Qualifications:

• Registered Nurse (RN) OR licensed clinician with current, unrestricted license in Illinois

• Minimum of 3 years of clinical practice experience performing HEDIS medical record review

• Minimum of 3 years of Healthcare or Managed Care experience, including quality improvement and/or project management experience

• Minimum of 1 year HEDIS medical record data abstraction

• Data analysis experience, skills and knowledge of statistical analysis software, and statistical methods and meaning knowledge

• Ability to adapt to changing priorities and managing a wide range of quality projects

• Verbal and written communication skills

• Problem resolution skills and ability to work with difficult situations with respect and diplomacy

• Presentation planning and delivery experience for provider training

Preferred Job Qualifications:

• REQUIRED - HEDIS experience

• Must have Project Management experience

• Clinical Quality Innovation

• NCQA - Working knowledge of managed care programs

*This role is a telecommute must live within 250 miles from posted location.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust …