Job Description:
The Quality Improvement Specialist is responsible for implementing various quality of care initiatives to support HEDIS/NCQA/IHA/CMS Stars quality measure performance and related activities. Specifically, this role works in close collaboration with physician practices, patients, and cross-functional departments within the organization to improve performance on clinical quality measures.
Key Responsibilities and Tasks:
- Support Clinical Quality team with implementing quality improvement initiatives, analyzing clinical data, and compiling information into spreadsheets and databases
- Develop clinical quality tip sheets, toolkits, and resources for distribution along with care gap reports to physician practices
- Abstract clinical information from electronic health records, and input data accurately into patient registry (Cozeva) to improve clinical quality measure performance
- Determine if medical chart documentation meets audit requirements of HEDIS/NCQA clinical measure specifications and guidelines
- Engage with physician practices to educate on clinical quality measures, train on patient registry (Cozeva), and conduct tailored campaigns to close care gaps
- Directly outreach to patients to assist in closing care gaps; coordinate care with physician offices, pharmacies, and other providers
- Ensure project tasks/deliverables are completed appropriately and on time; identify and communicate issues to management and stakeholders in a timely manner; proactively identify risks and work with stakeholders to mitigate them.
Skills and Experience Required:
- Bachelor's degree with relevant experience in a healthcare setting OR minimum 3 years of relevant experience in a healthcare setting
- Experience with HEDIS/NCQA clinical quality measures
- Knowledge of electronic health records and ability to quickly learn new software
- Advanced Microsoft Excel skills
- Strong analytical, critical thinking, and problem solving skills
- Excellent oral and written communication skills
- Demonstrated ability to exercise independent judgment and problem solve under pressure of deadlines and resource constraints
- Demonstrated ability to work on multiple projects and/or perform more than one function on a given project
Additional Information:
Salary: $97,000 - $127,000 Annual
