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Onsite Clinical Quality Research Analyst 29726

4 months ago

Chicago, United States Solving IT Full time

One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team

This Contract role as an Onsite Clinical Quality Research Analyst in Chicago, IL will be responsible for conducting data collection and abstraction of medical records for HEDIS and Quality projects including supplemental data collection. Responsible for interacting with various internal staff, internal departments, and network providers/IPA's to ensure quality performance and results for managed care products. Responsible for auditing all aspects of clinical quality improvement projects and evaluating PCP/MG/IPA compliance with clinical practice guidelines. Also responsible for data analysis, interaction with providers, practices and IPAs to educate on HEDIS measures, gaps in care and quality programs. Translate data into actionable information and determine areas for improvements as well as help implement actions toward improvement and report results to internal and external customers.

 

 

Responsibilities:

  • Interact with various internal departments, network practitioners, and MG/IPAs to ensure quality for managed care products.
  • Responsible for auditing, analysis of clinical data, and interaction with providers to translate data into information, determine areas for improvement, and help implement actions toward improvement.
  • Conduct audits for HMO Clinical Quality Improvement Projects.
  • Analyzes data and creates reports for statistically significant random samples regarding inter-rater reliability.
  • Reports findings to project-specific workgroups and management.
  • Identifies opportunities for improvement.
  • Assists with implementation of corrective action plans.
  • Re-audits to evaluate effectiveness of interventions.
  • Develop reports and presents findings to QI, Workgroups, as well as the Managed Care Quality Improvement Committees regarding HMO, PPO/FEP and POS quality improvement issues.
  • Perform quantitative and qualitative analysis for HMO and POS Clinical Quality Improvement projects.
  • Creates detailed Quality Improvement Activity reports required for NCQA accreditation, evaluates outcomes, works with Quality Management Specialists to determine opportunities for improvement, and helps implement actions toward improvement.
  • Documents actions taken for improvement and measures the impact of interventions to determine if changes or improvements are statistically significant.
  • Conduct formal presentations, reporting results from oversight of delegated Behavioral Health continuity and coordination performance Medical Management audits, HMO Clinical Quality Improvement QI Fund Projects, and provider appeal data analysis at project-specific, HEDIS and Quality Improvement Workgroups.
  • Perform onsite and concurrent audits for HEDIS Effectiveness of Care clinical indicators during data abstraction process, evaluate interrater reliability through analysis of employee-specific results, reports results to staff and management, assists with re-training employees on areas with identified deficiencies and evaluating the effectiveness of re-training.
  • Communicate and interact effectively and professionally with co-workers, management, customers, etc.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.? Maintain complete confidentiality of company business.
  • Maintain communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

Requirements:

  • Registered Nurse (RN) OR licensed clinician with current, unrestricted license in Illinois
  • Minimum of 3 years of clinical practice experience performing HEDIS medical record review
  • Minimum of 3 years of Healthcare or Managed Care experience, including quality improvement and/or project management experience
  • Minimum of 1 year HEDIS medical record data abstraction
  • Data analysis experience, skills and knowledge of statistical analysis software, and statistical methods and meaning knowledge
  • Ability to adapt to changing priorities and managing a wide range of quality projects
  • Able and willing to travel
  • Verbal and written communication skills
  • Problem resolution skills and ability to work with difficult situations with respect and diplomacy
  • Presentation planning and delivery experience for provider training

Preferred Requirements:

  • Working knowledge of managed care programs and NCQA and/or URAC Accreditation guidelines
  • Project management experience and skills

Benefits: 

Solving IT, a Woman and LGBTQ+ owned and operated organization is thrilled to provide a comprehensive benefit package to all our W2 employees and their families, regardless of gender. We are proud to offer five diverse health plan options as well as a PPO dental plan through Blue Cross Blue Shield, Term Life/AD&D Insurance, and a 401(k) Savings Plan. Solving IT covers a portion of the health and dental premiums for our employees. 

As you progress in your professional journey, Solving IT is dedicated to accommodating your evolving preferences and matching you with fulfilling projects. We champion equality and embrace diversity in all its forms. Creating an atmosphere that encourages varied perspectives to collaborate fosters personal development, strengthens team unity, and contributes to the overall success of the organization 

Whether you're seeking your next career challenge or aiming to stay abreast of industry trends, Solving IT is committed to supporting your career advancement. We actively encourage applications from all backgrounds and utilize the most up-to-date market insights and compensation data to ensure that you receive not just advice, but the complete Solving IT Experience.