HEDIS/Quality Improvement Nurse (LVN/RN)

Austin TX

Responsibilities

 

  • Year-round chart abstraction/Medical Record review, including record requests, documentation and storage
  • Assist with completion of HEDIS roadmap items and audit preparation
  • Act as a HEDIS/STARS SME for internal and external stakeholders
  • Day to day management of CCIP’s
  • Assist clinical staff in mapping processes to support administrative extraction of HEDIS data as needed
  • Assist in designing clinical intervention plans to better support measures HEDIS/STARs measures
  • Conduct quality monitoring and review functions as assigned
  • Assist with HEDIS, STARS, CAHPs Stakeholder education and development of supporting materials
  • Able to conduct quantitative and qualitative analysis of data to identify needed areas of improvement
  • Collaborate with staff to facilitate improvement initiatives
  • Proficient understanding and application of Continuous Quality Improvement (CQI) principles
  • Facilitate completion of key Quality initiatives including health screening programs and disease management measurement
  • Support completion of core Quality documents (evaluation, program description, P&Ps, work instructions)
  • Maintain and enhance relationships between the business and the provider community/vendors to support quality outcomes
  • Maintain NCQA IDSS tool proficiency
  • Collaborate with Risk Adjustment to limit provider abrasion regarding record requests and ensure information sharing
  • Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts as per PDSA/PDCA methodologies
  • Provides consistent and accurate documentation and information
  • Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines
  • Collaborate with stakeholders to ensure members move through the continuum of care according to best practices with the goals of facilitating quality health care
  • Other duties as assigned

 

 

 

 

Requirements

 

  • Degree in nursing from an accredited university
  • Licensed LVN or RN
  • CPHQ, and or Six Sigma Green Belt preferred
  • 1 – 8 years’ related experience in managed care, public health or related field
  • Previous experience in Medicare Advantage and Medicaid programs is a plus
  • Experience with ESRD and/or dialysis is a plus
  • Ability to navigate various types of documentation software
  • Knowledge and understanding of accreditation planning and assessment methodologies and tools
  • Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures
  • Skill in organizing resources and establishing procedures
  • Ability to educate staff regarding quality improvement requirements and deliverables
  • Effective time management
  • Capable of priority setting

 

 

 

 

Note: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, we will keep your resume on file for future opportunities and may contact you for further discussion.

 

#LI-MR1

Date Posted 8/2/2018
Salary Open






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