State Licensed Quality Improvement Specialist

Job Summary

A company is looking for a Quality Improvement Specialist (HEDIS) IRR & Overreads.

Key Responsibilities

• Train providers, health plans, and staff on continuous quality improvement methodologies and HEDIS processes
• Provide clinical support for medical record abstraction, over-read, and audit processes
• Analyze and monitor performance on quality indicators and report on progress of quality performance improvement plans

Required Qualifications, Training, and Education

• Bachelor's degree in Nursing, Healthcare, or Quality, or equivalent healthcare experience
• Experience in HEDIS or NCQA preferred
• Valid state clinical license preferred (e.g., LPN, RN)
• Knowledge of Excel and familiarity with abstractions or overreads