Quality Improvement Specialist

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Position:Quality Improvement Specialist

Position Summary:Responsible for implementing and adhering to Health Plan quality improvement initiatives set forth by the overarching goals of the Quality Improvement Program. Utilizes a working knowledge of HEDIS quality measure specifications to provide preventative health services to Health Plan members. Helps ensure quality of care through maintaining high Star/HEDIS rates.

Job Description:

Primary Responsibilities

• Coordinates and supports HEDIS projects through moderately complex medical record retrieval and abstractions.
• Handles data entry and validation of HEDIS Supplemental data. Ensures all data is compliant with all applicable regulations and policies.
• Maintains a 95% accuracy rate on all MRR.
• Coordinates and supports multiple critical quality improvement initiatives, such as health advocate programs, medication adherence programs, survey outreach, task follow up, quality of care reviews, data auditing, member outreach, etc. 
• Provides administrative support for routine health care or health plan correspondences.
• Conducts telephonic outreach and administers surveys to providers/members to close gaps in care for all contracted health plans or health systems. Contributes to improved member health through education and follow ups. 
• Collaborates with providers/provider groups regarding medical record requests. Helps identify any barriers.
• Monitors targeted measure specific quality programs as needed.
• Documents quality of care concerns in the appropriate system application for Medical Director review.
• Performs other duties as assigned.

Qualifications

• Bachelor's degree in health-related field or equivalent
• 3+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role
• Working knowledge of MS Office applications including Word, Excel, Outlook, and PowerPoint
• Good knowledge of quality improvement best practices 
• Effective time-management and project management skills, including the ability to plan, interpret moderately complex processes/programs, and resolve/escalate issues in a timely fashion
• Ability to be flexible, meet stringent deadlines, multi-task, prioritize work, and respond to changing demands/timelines
• Favorable problem-solving skills
• Effective verbal and written communication skills
• Good interpersonal skills and the ability to effectively interact at all levels

Preferred

• Previous Managed Care experience
• Medical Assistant, LPN, or equivalent clinical experience

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

#LI-Remote

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

$54,800.00-$73,250.00

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position: No- Not Member or Patient Facing Position

Location:Remote, USA

Time Type:Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.