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Quality Management Consultant

4 months ago

Woonsocket, United States CapLeo Global Full time
Position Title: Quality Management Consultant
Duration: 03 Months with possibility of extension
Location: Remote
Shift hours: M-F 8-5

Job Description:
The QM Consultant develops and implements data-driven strategies/interventions that ensure the delivery of time sensitive health benefits and services for members.
The QM Consultant directs coordination of care between the member, clinical care team, and providers and takes part in the analysis and reporting of member data to monitor outreach effectiveness.
The QM Consultant conducts targeted member/provider education and outreach initiatives and supports the development of HEDIS interventions and initiatives within the Quality Management Team.
The QM Consultant reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with HEDIS, regulatory, and accreditation requirements for member and/or provider issues.
This position independently coordinates the clinical resolution for members with health needs with internal/external clinician support as required.

Qualification:
5 years' experience in a clinical role or health related field, license and master's degree preferred.
Bachelor's degree, Nursing degree, or other comparable healthcare experience.