Clinical - Quality Improvement Specialist (Clinical) - 740014

Job Description:



Job Title: Quality Improvement Specialist (Clinical)
Duration: 4 months (Possible Extensions)
Location: Remote
Schedule: Monday Friday, 8:00 AM 5:00 PM EST
Max XXXX: XXXXXXXXXXX - XXXXXXXXXXX/hr. on w2.
Interview: Microsoft Teams On Camera Required

Position Overview

We are seeking an experienced Quality Improvement Specialist (Clinical) to support the HEDIS Operations team with year-round chart abstraction and overread activities . The specialist will review medical records, abstract and validate clinical data, analyze quality measures, and support quality improvement initiatives.
The ideal candidate will have strong HEDIS and clinical chart abstraction experience , particularly TRC (Transitions of Care) abstraction , along with knowledge of NCQA Technical Specifications , medical record review, and quality improvement methodologies.
This is a temporary, project-based opportunity driven by business growth. The team operates in a highly collaborative environment and values strong communication, attention to detail, adaptability, and a positive, can-do attitude.

Key Responsibilities

• Perform HEDIS chart abstraction and overread activities based on assigned measure priorities.
• Complete approximately 50 75 abstractions/overreads per day while maintaining accuracy and productivity.
• Review medical records and clinical documentation to identify and abstract required quality data.
• Perform TRC (Transitions of Care) abstraction and overread , with strong TRC experience preferred.
• Apply NCQA Technical Specifications and HEDIS measure requirements accurately during chart review.
• Monitor established contractual quality indicators and analyze, track, and trend results.
• Support development and implementation of Quality Performance Improvement Plans (PIPs) using the PDSA model .
• Monitor PIP progress and support activities through successful closure.
• Provide clinical support for medical record audit processes .
• Prepare and contribute to formal quality reports for the Quality Management Committee and Executive Management .
• Train providers and staff on continuous quality improvement methodologies and tools as needed.
• Participate in meetings with committees, state agencies, providers, and other stakeholders.
• Collaborate with HEDIS Operations and quality teams using Microsoft Teams and other communication tools.
• Maintain accurate documentation while meeting established quality, productivity, and compliance standards.

Required Qualifications

• GED or equivalent required.
• LPN or RN license required.
• Minimum 2+ years of relevant experience .
• Strong experience with clinical chart abstraction and overread .
• Experience reviewing medical records and clinical documentation .
• Strong understanding of HEDIS quality measures .
• Knowledge of NCQA Technical Specifications .
• Strong attention to detail and ability to identify relevant clinical information within medical records.
• Strong written and verbal communication skills.
• Ability to work independently while contributing effectively to a collaborative remote team.
• Ability to manage high-volume work and consistently achieve productivity and accuracy expectations.
• Microsoft Office proficiency .

Preferred Qualifications

• Bachelor's degree in a related field.
• Master's degree preferred.
• HEDIS abstraction experience .
• TRC abstraction experience .
• Quality improvement/quality management experience.
• Experience with PIPs and PDSA methodology .
• Experience in behavioral health and/or physical health quality improvement.
• Certified Professional in Health Care Quality (CPHQ).
• Experience with healthcare quality reporting and medical record audits.

Top 3 Must-Have Skills

1. Strong HEDIS Chart Abstraction / Overread Experience
2. Strong NCQA Technical Specification / HEDIS Measure Knowledge
3. Microsoft Office

Performance Expectations

• Complete approximately 50 75 chart abstractions/overreads per day .
• Maintain high levels of accuracy, productivity, and attention to detail .
• Demonstrate strong knowledge of assigned HEDIS measures and NCQA specifications.
• Meet project deadlines and quality standards.
• Effectively communicate and collaborate with the HEDIS Operations team.