Clinical Quality Improvement Specialist (HEDIS) 112274
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Job Location:
Columbus, NE - USA
Monthly Salary:
Not Disclosed
Posted on:
4 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Title: Quality Improvement Specialist (HEDIS)
Location: Onsite Columbus Ohio 43219 (Daily commute required)
Assignment Duration: 4 months
Work Schedule
- Standard 8-hour workday
- Start time: 8:00 AM (0.5 1 hour lunch)
- Flexibility available with prior approval
Position Summary
The Quality Improvement Specialist (HEDIS) supports quality improvement initiatives focused on HEDIS Hybrid Operations. This role provides clinical and operational support for medical record review abstraction over-read and audit activities. The position plays a key role in identifying care gaps supporting quality metric performance and contributing to annual HEDIS chart chase activities.
Key Responsibilities
- Support HEDIS hybrid medical record abstraction over-read and audit processes.
- Provide clinical guidance and quality oversight during chart review activities.
- Train providers health plan staff and internal teams on HEDIS methodologies abstraction standards and quality improvement tools.
- Monitor performance against established quality indicators and contractual benchmarks.
- Analyze track and trend quality data to identify improvement opportunities.
- Recommend develop and support quality performance improvement plans (PIPs) using the PDSA model.
- Monitor and report progress of PIPs through completion.
- Participate in meetings with internal teams providers vendors and external stakeholders.
- Maintain compliance with organizational policies procedures and quality standards.
- Perform additional quality-related duties as assigned.
Typical Day in the Role
- Review and support medical record abstraction and quality review workflows.
- Collaborate closely with abstractors over-readers auditors and leadership staff.
- Track productivity metrics and quality indicators aligned with permanent staff benchmarks.
- Participate in scheduled and ad-hoc team meetings.
- Work onsite in a structured collaborative office environment.
Education & Experience
Preferred:
- Bachelors degree in Nursing Healthcare Quality or a related field
- Experience with HEDIS NCQA standards or quality improvement programs
- Clinical background (RN LPN or similar) preferred but not required
Required:
- Demonstrated experience in quality improvement HEDIS operations or medical record review
- Proficiency in Microsoft Excel (sorting filtering formatting basic formulas and simple visualizations)
Required Skills & Competencies
- Strong attention to detail and data accuracy
- Ability to work with fax machines and document scanners
- Basic to intermediate Excel skills
- Analytical thinking and problem-solving abilities
- Effective verbal and written communication skills
- Ability to collaborate in a fast-paced metrics-driven environment
Performance Expectations
- Meet established daily productivity and quality benchmarks for record requests intake abstractions and assigned tasks.
- Maintain accuracy and compliance consistent with permanent staff standards.
Work Environment
- Onsite office setting
- Collaborative team environment with regular interaction across quality and clinical teams
- Structured schedule with defined productivity expectations
Key Skills
- Quality Assurance
- FDA Regulations
- Data Collection
- Food Safety Experience
- ISO 9001
- Mobile Devices
- Root cause Analysis
- Quality Systems
- OSHA
- Food Processing
- Quality Management
- cGMP
