This position is responsible for the implementation of Quality processes, including related work plans for the HEDIS Department. The clinical advisor will be responsible for developing and implementing all HEDIS Reporting and Quality Improvement activities for assigned PCP’s and work areas. This will also include report preparation, distribution, and follow-up monitoring for all HEDIS, quality assurance, and performance improvement activities within the organization. The Clinical Advisor will have direct responsibility for the HEDIS and Quality outcomes which will include a comprehensive and on-going reporting system, designed to objectively and systematically monitor and evaluate PCP performance and company results.
Responsibilites:
- Responsible for the update and implementation of HEDIS Quality Improvement processes including the training of PCP’s and office staff when necessary.
- Responsible for delivering timely reports and following up with every assigned PCP in the work area.
- Ensuring systematic identification and follow-up of potential quality/compliance issues.
- Responsible for assisting with the development of policies and procedures to ensure regulatory compliance including HIPAA requirements.
- Develops and monitors action items identified to insure the highest HEDIS results are achieved.
- Works closely with all DHCP departments, staff, administration and participates in status meetings and training as needed.
- Knowledge of current Medicare Advantage and health plan operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines.
- Excellent organizational skills
- Ability to work well under pressure and in situations requiring flexibility and last-minute schedule changes.
- Capable of addressing a variety of issues while driving momentum of key initiatives.
- Must have significant experience in developing and implementing HEDIS programs for successful department and organization results.
- Must demonstrate understanding and compliance with NCQA, CMS, Federal and State reporting and operational guidelines.
- Must participate proactively with the pursuit of methods to improve care and service to members through implementation of quality improvement studies and projects.
- Educating staff, members, physicians, and other providers about company goals, objectives and structure for providing quality, cost effective, and coordinated managed health care.
- Must always promote open communication and interaction between providers, staff and members regarding the organization’s HEDIS and quality improvement efforts.
- Assist with development of an Annual Quality Improvement Work Plan.
- Assist with the Annual Evaluation of the Quality Improvement Program and activities.
- Creating and compiling HEDIS-related reports for internal and external distribution regarding quality and performance improvement activities and studies.
- Responding to requests from Senior Leadership regarding quality related issues/concerns.
Qualifications:
- Progressive experience in a managed care environment, particularly with Medicare Advantage Plans and SNPs
- Start-up experience in a managed care environment
- Previous HEDIS and quality improvement experience
- Experience in strategic planning and development
- Knowledge of Quality reporting, including nuances and challenges
- Demonstrated leadership skills in working with clinical professionals and office staff
Education and/or Experience:
- FMG or MD candidate or Master’s degree in nursing, health administration, or health care quality management or BSN Degree and 5 to 10 years of work experience in the health administration field with managed care and quality improvement experience
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
4gqhm6zweR