Quality Nurse HEDIS - HP Medical Management

Summary:

The HEDIS Program Manager Health Plan Quality Improvement will work in collaboration with the HEDIS Manager to assist in consistently developing the HEDIS program according to accreditation changes, provide constant feedback on program progress and suggest action plans for any deviation from the set goal. The HEDIS Program Manager will develop and coordinate the education activities as well as the roll out to providers and staff that will enhance and keep the program progressing and will collaborate directly with the Manager Health Plans Quality HEDIS, and other team members to ensure compliance with accreditation requirements are in place and re-engineered within appropriate timeframes. This role will conduct routine readiness assessment, evaluations of procedures, as well as programs for CAHPs, and other HEDIS initiatives.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Active collaborator with multiple internal departments to create and implement various programs /plans under the Quality program/banner.
• Manage care gaps in collaboration with other teams and provider offices.
• Responsible for over reading abstracted HEDIS measures.
• Observe and Identify trends and potential strategies by collaborating with the HEDIS Manager, Director of Health Plan Quality, Chief Medical Officer, and health plan staff.
• Track and trend barriers/challenges that exist to achieve better outcomes, including access to appointments, lack of follow up, or documentation.
• Develop and initiate HEDIS training for both internal and external customers.
• Facilitate communication between providers and health plan to optimize health and wellness, reduce inpatient admission, reduce re-admissions and improve medical stability in the patient population served.
• Responsible for the coordination of HEDIS data, gathering processes by evaluating quality and completeness of clinical documentation processes.
• Assist to create patient and provider collateral for HEDIS and CAHPS programs.
• Participates in the development and ongoing implementation of quality improvement activities by providing regular and ongoing provider/staff support and education.
• Performs all other related duties as assigned.

Job Requirements:

Education/Skills

• Bachelor’s or associate degree – Registered Nurse or Vocational/technical school graduate - Licensed Vocational Nurse

Experience

• 4 years of clinical experience preferred.
• HEDIS experience required, 4 or more years.
• Educator/Trainer experience preferred.
• Oral and written presentation skills Preferred.
• EMR experience
• Experience collaborating with providers and staff.
• CAHPS experience

Licenses, Registrations, or Certifications

• RN/LVN license required.

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time