Immediate need for a talented Clinical - Quality Improvement Specialist (HEDIS). This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID: 26-34096
Pay Range: $19/hr - $20/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Conduct medical record research, review, and abstraction to support HEDIS quality measures and gap closure.
- Provide clinical support for medical record abstraction, over-read, and audit processes.
- Apply NCQA technical specifications and HEDIS guidelines to ensure accurate and compliant reviews.
- Monitor, analyze, track, and trend quality performance indicators.
- Support fax-based medical record retrieval projects and follow up on outstanding records.
- Assist with the development and implementation of Performance Improvement Plans (PIPs) using the Plan-Do-Study-Act (PDSA) model.
- Collaborate with internal teams, providers, health plans, vendors, and other stakeholders to achieve quality improvement goals.
- Prepare reports and communicate project progress and results.
Key Requirements and Technology Experience:
- Bachelor’s degree in Nursing, Healthcare, Quality, or a related field, or equivalent relevant healthcare experience.
- Experience with HEDIS gap closure and NCQA requirements.
- Knowledge of NCQA technical specifications and the ability to navigate and apply them.
- Strong medical terminology and medical record review skills.
- Proficiency in Microsoft Office, particularly Excel and Word.
- Strong analytical, documentation, and communication skills.
- Experience in HEDIS abstraction, quality improvement, medical coding, data analytics, or healthcare compliance.
- Previous experience supporting HEDIS Hybrid Operations or medical record retrieval and review projects.
- An active clinical license, such as LPN or RN, is preferred but not required.
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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