Vacancy Description
Position Summary
:The Clinical Quality Specialist RN is responsible for clinical elements of the PQI process for the Plan, participating in the HEDIS process, participating in NCQA activities, as well as implementing quality interventions and conducting evaluation to ensure on-going feedback and program effectiveness.
Essential Functions and Responsibilities:
Provides clinical knowledge (i.e. clinical standards of care, best practices) and support for Potential Quality Issues (PQI) for all lines of business for the Plan.
Investigates and responds timely to Potential Quality Issues (PQIs).
Participates in the annual HEDIS process.
Serves as subject matter expert on the certified HEDIS software system for support of the HEDIS process and other quality projects/reporting.
Works with manager in developing and promoting HEDIS initiatives, participating in applicable Quality Committees, and work grou...
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