Clinical Quality Specialist RN - Peak Health
欢迎你！我们很高兴你正在考虑与我们一起获得机会！申请这个职位并被考虑，请点击此消息上方的应用按，并在完整完成申请。下面，你将找到有关该职位的其他重要信息。临床质量专家将成为峰值健康品质团队的一个组成部分。本职位负责监督绩效改善活动，确保符合法规和其他导致有效提高质量的举措。在此职位中，你将协助 HEDIS 计划进行医疗记录检索和抽象工作，与提供商密切合作以确保准确完整的文档化，并与 HEDIS 项目经理和质量经理合作实施绩效改善倡议。另外，临床质量专家将参与表现监测和评估以及收集和分析数据来评估结果。最低资格：教育，经验，认证和/或许可：1.. 通过增强护士许可协议 (eNLC) 和4 (4) 年的医疗保健临床经验或与商业相关领域学历以及6 (6) 年的卫生保健质量管理或在健康计划，医院或医生实践中绩效改善。优先资格：教育，认证和/或许可证：1.护理学士学位或护理学博士学位 (ASN) 或文凭；目前已入读 BSN 课程并完成 BSN 工作三 (3) 年内。经验：1 . 3. 了解 CMS 指导方针，法规，NCQA®和 HEDIS®. 4. 对绩效改善项目 (PIPs) 的全面知识，并能够在 PIP 编写开发，更新和分析数据中应用这些知识。5. 可以与大型数据集进行工作，分析信息并提供建议。主要职责和责任：这里描述的声明旨在描述被分配到这个职位的人所执行的工作的一般性质。它们不旨在构成所有责任和义务的综合清单。
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Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.
The Clinical Quality Specialist will be an integral member of the Peak Health’s quality team. This position is responsible for overseeing performance improvement activities, ensuring regulatory compliance, and other initiatives that lead to effective improvements in quality.
In this role you will support the HEDIS program by assisting with medical record retrieval and abstraction, working closely with providers to ensure accurate and complete documentation and collaborating with the HEDIS Program Manager and Quality Manager to implement performance improvement initiatives. Additionally, the Clinical Quality Specialist will be involved in performance monitoring and assessment and gathering and analyzing data to evaluate outcomes.MINIMUM QUALIFICATIONS:
EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:
1. Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC) AND Four (4) years of healthcare clinical experience
OR
Bachelor’s degree in healthcare or business-related field AND Six (6) years healthcare quality management or performance improvement in a health plan, hospital, or physician practice.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion within three (3) years of hire.
EXPERIENCE:
1. Managed Care knowledge or experience
2. Three (3) years Quality Management, Quality Improvement or Process Improvement Experience.
3. Knowledge of CMS guidelines, regulations, NCQA® and HEDIS®.
4. Thorough knowledge of Performance Improvement Projects (PIPs) and is able to apply that knowledge in PIP writing development, update, and analysis of data in PIPs.
5. Able to work with large data sets and analyze information and provide recommendations.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI) through HEDIS compliance rate tracking, trending and analysis as well as identifying existing challenges, inefficiencies and areas in need of improvement or intervention3. Assume accountability for HEDIS/Stars improvement activities including medical record review, chart collection, and member or provider interventions or education to improve HEDIS compliance rates for Medicare HEDIS/STARS measures.
4. Assist in preparing the annual QI evaluation report and plan/program documents.
5. Review medical records and other documentation to ensure quality care is being provided.
7. Ensure workflows, policies, procedures, regulatory and accreditation standards are implemented and maintain compliance for clinical programs.
8. Investigate potential quality of care issues that may affect the quality or safety of the health of members
9. Evaluate reports for continued compliance with clinical quality requirements.
10. Actively participate in quality committee, assist in developing annual work plans, program descriptions, and evaluations.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1.Standard office environment
SKILLS AND ABILITIES:
1. Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, URAC, and/or NCQA accreditation standards, including HEDIS/STARS.
2. Excellent written and oral communication
3. Problem solving capabilities to drive improved efficiencies and customer satisfaction
4. Attention to detail
5. Proficiency with Microsoft Office
6. Medicare experience preferred
7. Remote for the most part, will have expectations to come in on as-needed basis
Additional Job Description:
Scheduled Weekly Hours:
40Shift:
Exempt/Non-Exempt:
United States of America (Exempt)Company:
PHH Peak Health HoldingsCost Center:
405 PHH Quality ManagementOriginally posted on Himalayas