Quality Improvement Specialist
6 days ago
Become a part of our caring community and help us put health first.
Job SummaryWe are seeking a Quality Improvement Professional 2 who will implement the Health Plan's QI Program.
Key Responsibilities- Compliance to Accreditation, State, Federal Regulations:
- Participate in required audits to meet accreditation and regulatory requirements.
- Participate with corrective action plans.
- Assist with survey preparation, committee preparation, presentation, documentation.
- HEDIS:
- Collect, research, reviews during annual HEDIS Chart Review season.
- Participate in strategy, training, planning, implementation meetings.
- Quality Issues Resolution Process:
- Review/investigate potential quality issues following established policies and implementation of appropriate/timely actions.
- Peer Review Committee Process:
- Assist with and/or attend Peer Review Committee (PRC) activities.
- Assist with documents to be presented to PRC.
- Medical Record Documentation Review (MRDR):
- Review medical records for medical record keeping practices and recommend quality improvements.
- Special Projects:
- Participation in work groups/lean projects/task forces, which may include but are not limited to analysis and improvement activities, community outreach and partnerships.
- Bachelor's degree
- Reside in FL, GA, NC or SC
- 3 or more years clinical and/or health plan experience
- RN active unrestricted compact license or FL license
- Experience in a fast-paced insurance or healthcare setting
- Experience in provider relations
- Understanding of healthcare quality measures STARS, HEDIS, etc.
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
- Proven analytical skills
- Knowledge of Humana's internal policies, procedures and systems
- Experience in quality management
- Certified Professional in Healthcare Quality (CPHQ)
Travel- 5%
This job is eligible for a bonus incentive plan.
This incentive opportunity is based upon company and/or individual performance.
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