Quality Initiatives Specialist

JOB REQUIREMENTS: OVERVIEW The MCIC Quality Initiatives Specialist supports initiatives that improve behavioral and medical health outcomes for MercyCare Health Plan members and providers. In this role, you will analyze clinical quality data, identify trends, forecast performance, and present findings to support NCQA standards, HEDIS measures, and applicable state and federal requirements. You will use these insights to plan and carry out quality improvement projects, coordinate member and provider outreach, and facilitate referrals to disease and case management programs. SCHEDULE: 40-hours per week SHIFT: Days ESSENTIAL DUTIES AND RESPONSIBILTIES Acts as a lead specialist to provide project, program and /or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments. Assists in monitoring and analyzing outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met. Program and support Microsoft Access databases to manage targeted disease populations and provide efficiencies in work processes. Design and implement strategies for outcomes improvement based on membership population characteristics and business functions requirements. Participate in the implementation of Continuous Quality Improvement activities by contributing front line knowledge of projects and observations. Develop optimal alternative solutions based on feedback and environmental analysis. Implement process improvement using innovative thinking, root-cause-analysis, process mapping, and charting techniques. Complete Quality Initiative projects according to specifications and requirements. This includes: Following project policies and procedures. Accurate audit of measures. Data management: interfacing with and utilizing various software and portals for auditing and submitting data. Writing and updating policies and procedures. Provide follow up and education of providers and clinic staff on measures and project objectives. HEDIS / Quality Reporting Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review Assists Manager in training and takes the lead role in these activities: Abstract data from the medical records and loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed. Works with the corporate HEDIS team to monitor accuracy of abstracted records as required by specifications. Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors. Assists the quality improvement staff with physician and... For full info follow application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/4E6F26D2CEEC48DB