Quality Practice Liaison (Must be licensed in Arizona or Multi-State)

Quality Practice Liaison

We're building a world of health around every individual shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person, one family and one community at a time.

This is a full-time Quality Practice Liaison opportunity with the Arizona Mercy Care Plan. The working schedule is Monday-Friday during normal business hours. This is a typical office working environment with productivity and quality expectations. The Quality Practice Liaison position is a work at home role. This person must be comfortable presenting HEDIS gaps in care data to provider groups, including HEDIS (Healthcare Effectiveness Data and Information Set) measure education and best practice information. This person will be responsible for obtaining, reviewing, abstracting, and data entering medical records utilized for HEDIS supplemental data processes.

The Quality Practice Liaison must understand the NCQA (National Committee for Quality Assurance) HEDIS technical specifications for the designated HEDIS supplemental data measures. This person must also be able to apply understanding of the technical specifications in the process to review, abstract, and data enter supplemental data, as well as collaborate with the health plan HEDIS project managers and other health plan departments (which may include - but is not limited to - member services, provider relations and integrated care management) to achieve the common goal of improving member outcomes, as measured by the HEDIS/STAR measures.

The Quality Practice Liaison must be comfortable accessing a variety of EMR systems remotely to obtain and abstract medical record data per specifications. Please note that telework requires the ability to be self-motivated and be a proactive employee. Volume and accuracy expectations will be communicated and are expected to be met. Work requires the ability to read and interpret medical record documentation, both computer-generated and handwritten, as well as sitting at a workstation for extended periods of time typing on the computer.

Primary Responsibilities

• Generates and distributes gap in care reporting from Tableau Dashboard.
• Actions outreach, scheduling meetings, developing presentations, and conducting meetings with provider groups to share HEDIS information.
• Reviews documentation and abstracts compliant medical record data for entry into supplemental data tool.
• Contacts the providers of record, vendors, or internal Aetna departments to obtain additional information as needed.
• Commands a comprehensive knowledge of NCQA HEDIS and STARS Measures for both Medicare and Medicaid.
• Works with a variety of electronic tools to accomplish team goals.
• Performs other duties as needed.

Required Qualifications

• Active and unrestricted Arizona or compact state RN (Registered Nurse) license.
• 3+ years of clinical experience as an RN.
• 2+ years of experience with HEDIS quality measures.
• 1+ years of experience with delivering presentations.
• Demonstrated proficiency technology, keyboarding, and various systems, including Microsoft Outlook, Teams, Word, Excel, PowerPoint, Adobe Acrobat, Windows 10, and QuickBase.
• Willingness to travel in the state of Arizona up to 10% of time, if commutable.

Preferred Qualifications

• High level of accuracy and attention to detail.
• Self-motivated and comfortable working under tight deadlines.
• Professional customer service demeanor, good work ethic, and ability to self-motivate.
• Conscientious problem solver, with a demonstrated willingness to learn.
• Proven organizational and time management skills.
• Excellent verbal & written communication skills, with a focus on clear, concise, and appropriate language.
• Experience with a variety of EMR (Electronic Medical Records) systems.
• Ability to multi-task, prioritize, and effectively adapt to a fast-paced, changing environment.
• Experience reading and interpreting medical records, including handwritten records.

Education

• Associate Degree in Nursing.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $54,095.00 - $155,538.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.