Quality Compliance Professional

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Engage in projects aimed at enhancing performance and quality.

• Execute targeted initiatives for members and providers to boost health outcomes and experiences.

• Contribute to multidisciplinary committees mandated by NCQA and the State Contract.

• Participate in and potentially lead quality improvement initiatives within the Kentucky market.

• Conduct outreach calls to members.

• Perform audits of medical records to assess provider adherence to clinical practice guidelines, best practices, and regulations.

• Reach out to providers to close gaps in care.

• Audit records to pinpoint opportunities for improvement.

• Abstract data from records to address care gaps.

• Update quality documentation, which includes descriptions of the quality improvement program, work plans, and evaluations.

• Attend meetings of the Quality Improvement Committee.

• Complete and refresh State Reports and reports for the Kentucky Medicaid Quality Improvement Committee.

• Travel quarterly to meetings in Louisville and attend provider visits as necessary within Kentucky.

⛳️ Requirements

• A minimum of 3 years of prior experience in member outreach regarding quality and performance improvement activities.

• At least 2 years of prior experience in healthcare quality improvement or quality operations.

• Familiarity with HEDIS, CMS, and Quality standards.

• Experience with healthcare quality measures, including HEDIS and CAHPS.

• Solid proficiency in Microsoft Office Word and PowerPoint.

• Intermediate skills in Excel, including the use of pivot tables, filtering, charts, and formulas.

• Must be a resident of the Eastern Time Zone.

• Ability to work independently with general supervision.

• Self-motivated and proactive.

• Bachelor's degree is preferred.

• Experience in quality improvement within the Medicaid population is preferred.

• Certification as a Professional in Healthcare Quality (CPHQ) is preferred.

• Previous experience in quality or process improvement within a hospital or physician office setting is preferred.

🏝️ Benefits

• Limited benefits available immediately upon hire.

• Paid time off.

• 401(k) retirement savings plan.

• Employee assistance program.

• Business travel and accident benefits.

• Option to work remotely from home.

• Dedicated workspace and internet requirements to facilitate remote work.