Quality Specialist

• Take a lead role in developing and maintaining quality improvement projects specific to HEDIS Hybrid Operations
• Serve as primary owner for assigned HEDIS measures
• Train providers, health plans, and staff in continuous quality improvement methodologies and tools, HEDIS abstraction, and over-read processes
• Provide clinical support to medical record abstraction, over-read, and audit processes
• Monitor performance on established contractual quality indicators
• Analyze, track, and trend results
• Prepare for and participate in meetings with committees, state agencies, providers, health plans, vendors, and stakeholders
• Recommend, develop, and implement quality performance improvement plans (PIPs) with management using the PDSA model
• Monitor and report PIP progress through closure
• Conduct year-round pseudo-claims performance, gap identification, and intervention and strategy planning for assigned HEDIS measures
• Support department leadership in project and strategy development
• Lead complex or high-risk HEDIS quality improvement initiatives with market-wide impact
• Provide guidance on complex abstraction scenarios, team training, measure interpretation, abstraction standards, and quality improvement best practices
• Mentor and serve as a resource to team members
• Perform other duties as assigned
• Comply with all policies and standards

Quality Specialist jobs in Missouri

Quality Improvement Specialist – HEDIS II