This position is a field-based quality position, responsible for supporting HCSCs quality imperatives and value-based care models and relationships by collaboratively working with Medical Groups, IPA's or individual PCPs, Medical Directors and Administrators and key staff to improve quality through measuring targeted HEDIS measures. This position requires a developed understanding of Quality and HEDIS to participates in program development and quality improvement activities inclusing retrieving and abstracting medical records, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions to support HEDIS improvement. This role provides ongoing and annual evaluation of the effectiveness of the overall Quality Improvement Program for the line of business assigned and is also responsible for creating and maintaining strong working relationships with the care coordination/care management and quality teams at the value based entity and internally with local Network Management and internal quality teams to provide consultative support serving as a single point of contact for quality and HEDIS needs and ensure day to day operational needs are being met.
Required Job Qualifications:
* Registered Nurse (RN) OR Physicians Assistant OR Nurse Practitioner with current, unrestricted license to practice in the state of operations
* 4 years experience in health insurance, managed care or medical group experience.
* Knowledge of federal and accreditation standards and regulations for the health insurance industry
* Experience in designing clinical programs
* Experience conducting presentations for member and/or provider training.
* Proven ability to work collaboratively with physicians
* Ability to work independently
* Effective communication and written skills and ability to communicate and influence internal and external customers at all levels of the organization
* PC skills and familiarity with various software packages including spreadsheets and presentations
* Ability to travel including overnight stays.
Preferred Job Qualifications:
* Prior experience in Quality Improvement Programs
* Prior experience and knowledge of HEDIS measures
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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