Quality Improvement Specialist

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Position:Quality Improvement Specialist

Position Summary:Responsible for implementing and adhering to Health Plan quality improvement initiatives set forth by the overarching goals of the Quality Improvement Program. Utilizes a working knowledge of HEDIS quality measure specifications to provide preventative health services to Health Plan members. Helps ensure quality of care through maintaining high Star/HEDIS rates.

Job Description:

Primary Responsibilities

• Coordinates and supports HEDIS projects through moderately complex medical record retrieval and abstractions.
• Handles data entry and validation of HEDIS Supplemental data. Ensures all data is compliant with all applicable regulations and policies.
• Maintains a 95% accuracy rate on all MRR.
• Coordinates and supports multiple critical quality improvement initiatives, such as health advocate programs, medication adherence programs, survey outreach, task follow up, quality of care reviews, data auditing, member outreach, etc. 
• Provides administrative support for routine health care or health plan correspondences.
• Conducts telephonic outreach and administers surveys to providers/members to close gaps in care for all contracted health plans or health systems. Contributes to improved member health through education and follow ups. 
• Collaborates with providers/provider groups regarding medical record requests. Helps identify any barriers.
• Monitors targeted measure specific quality programs as needed.
• Documents quality of care concerns in the appropriate system application for Medical Director review.
• Performs other duties as assigned.

Qualifications

• Bachelor's degree in health-related field or equivalent
• 3+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role
• Working knowledge of MS Office applications including Word, Excel, Outlook, and PowerPoint
• Good knowledge of quality improvement best practices 
• Effective time-management and project management skills, including the ability to plan, interpret moderately complex processes/programs, and resolve/escalate issues in a timely fashion
• Ability to be flexible, meet stringent deadlines, multi-task, prioritize work, and respond to changing demands/timelines
• Favorable problem-solving skills
• Effective verbal and written communication skills
• Good interpersonal skills and …