Quality Improvement Specialist – HEDIS II

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

📋 Description

• Assume a leadership role in the development and maintenance of quality improvement projects focused on HEDIS Hybrid Operations.

• Act as the primary owner for designated HEDIS measures.

• Educate providers, health plans, and staff on continuous quality improvement methodologies and tools, HEDIS abstraction, and over-read processes.

• Provide clinical assistance for medical record abstraction, over-read, and auditing procedures.

• Track performance against established contractual quality indicators.

• Analyze, monitor, and trend results.

• Prepare for and engage in meetings with committees, state agencies, providers, health plans, vendors, and stakeholders.

• Propose, develop, and implement quality performance improvement plans (PIPs) in collaboration with management using the PDSA model.

• Oversee and report on the progress of PIPs until completion.

• Conduct ongoing pseudo-claims performance assessments, gap identification, and develop intervention and strategy planning for assigned HEDIS measures.

• Assist department leadership in project and strategy formulation.

• Lead complex or high-risk HEDIS quality improvement projects that have a market-wide influence.

• Offer guidance on intricate abstraction scenarios, team training, measure interpretation, abstraction standards, and quality improvement best practices.

• Mentor team members and serve as a resource.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in a related healthcare field.

• Minimum of 2 years of experience in Quality.

• Strong preference for knowledge of HEDIS & performance measures.

• Must be authorized to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

• Advanced proficiency in all stages of clinical medical record abstraction, including data entry, over-read, and inter-rater reliability (IRR/third-level over-read).

• Functional and technical expertise regarding overall program requirements and operations.

• In-depth clinical abstraction knowledge for providing guidance on complex abstraction scenarios, team training, and measure interpretation.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.