United States,
Wall, New Jersey
Whittier, California
Linthicum Heights, Maryland
New York, New York
Hershey, Pennsylvania
Posted: 01-Nov-23
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 16179401
Summary:
The responsibilities of this position demands a team player as well as a wide range of capabilities including: program planning and analytic skills; strong understanding of HEDIS and coding; the ability to direct and motivate; highly developed communication skills; and the ability to develop a clear action plan and drive processes.. This position will facilitate and help with handling unresolved issues that remain as a result of a deviation from following the standard process. Collaboration between HEDIS Manager, Quality Director and Chief Medical Officer on improved innovation and process improvement. Work with the Quality Improvement team to collect member charts for review. Provide over site of abstracted records, quality assurance and data entry. Facilitate communication between providers and health plan to optimize health and wellness, reduce inpatient admission, reduce re-admissions and improve medical stability in the patient population served. Responsible for the coordination of HEDIS data, gathering processes by evaluating quality and completeness of clinical documentation processes. Performs quality medical record reviews, assisting providers and staff in the improvement of clinical documentation, identifying trends and gaps in care, connecting score cards to provider profiling, maintaining accurate records of review activities, ensures all data submitted to the health plan meets HEDIS technical specifications for medical records. Participates in the development and ongoing implementation of quality improvement activities by providing regular and ongoing provider/staff support and education.
- Manage care gaps in collaboration with the quality team, and provider offices.
- Request records from provider's offices as needed and perform a review of medical records for data collection, data entry, and quality monitoring, which allows health plan to review accuracy of documentation, and a possibility to close gaps in care.
- Responsible for over reading abstracted HEDIS measures.
- Observe and Identify trends and potential strategies by collaborating with the HEDIS Manager, QI Director, Chief Medical Officer and health plan staff.
- Track and trend barriers/challenges that exist to achieve better outcomes, including access to appointments, lack of follow up, or documentation.
- Communicate scheduling challenges or trends that may negatively affect quality outcomes.
- Activities will include data collection, data entry, quality monitoring, health plan and chart collection activities.
- Navigate multiple EMR systems and obtain medical record sections supportive of HEDIS measures.
- Maintains education / knowledge base of HEDIS / STARs.
- Training, oversight of team and department processes.
- Performs all other related duties as assigned.
Requirements:
- Bachelor's or Associates degree – Registered Nurseor Vocational/technical school graduate- Licensed Vocational Nurse
- Knowledge of lab procedures and diagnostic testing
- Ability to write clear documentation and ability to write detailed specifications
- Solid organizational skills including attention to detail and multi-tasking skills
- Basic computer skills
- EMR Experience
- 4 years clinical experience preferred
- HEDIS Experience required, 4 or more years.
- Experience working in a provider and/or medical office.
- RN or LVN/LPN License in the state of TX or where positions is located within the enterprise.
Work Type:
Full Time
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