Clinical - Quality Improvement Coordinator I
4 weeks ago
*50% of time on-site was one of the primary job functions: collection and processing of medical records that are received via mail (must be done onsite)"
SHIFT : Mon - Fri 8:00am-5:00pm
Job Description: Position Purpose:
- Communicate with provider practices to ensure that TRC/MRP have been completed and uploaded to the EMR. Additionally, these temps will audit medical records to confirm TRC/MRP included. Administrative tasks include requesting and processing medical records, as well as daily performance tracking.
- Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes.
License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. Utilization management certification preferred. Certified Professional in Healthcare Quality preferred.Perform duties and functions to comply with quality improvement programs according to state requirements.
Support Quality Assurance Performance Improvement work plan/initiatives.
Schedule and assist with committee and sub-committee preparation.
Assist in investigation and resolution of member quality of care complaints.
Audit medical records and monitor performance measures for health care risk management, sentinel events and trends Internal/External Groups with which the Candidate will interface: Internal HEDIS Team, State-wide (Ohio) provider groups Required Skills/Experience: Preferred Skills/ Experience: Send/Receive Fax, Email 1. HEDIS Experience Microsoft Office Programs (Excel, Word) 2. Familiarity with TRC HEDIS Measure Health Insurance/Healthcare/Clinical work (any) 3. Medical Records Experience Education Requirement: Associate's Degree or LPN Education Preferred: Bachelor's Degree (Nursing, other) Software Skills Required: Microsoft Office programs (Minimum: proficient; Preferred: advanced) Required Certifications: N/A, Active RN preferred Required Testing: Internal HEDIS Testing (after hire)
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