Quality Practice Advisor

Cypress, CA 90630

Posted: 04/02/2019 Category: Registered Nurse Job Number: 26478

Title: Quality HEDIS Advisor

Location: Cypress, California

Shift Hours: 8: 00-5: 00pm

Pay: $40.00 – $45.00

 

Position Summary-

· Establishes and fosters a healthy working relationship between large physician practices. Educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures.

· Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding.

· Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS.

· Acts as a resource for the market on HEDIS measures, appropriate medical record documentation and appropriate coding.

· Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.

Interested in setting up a phone interview screening? please contact Ashley Kruger at 877-782-3334 or email akruger@alinestaffing.com

Duties-

· Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.

· Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement.

· Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).

· Delivers provider specific metrics and coach providers on gap closing opportunities.

· Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations.

· Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education.

 

Education –

· A Bachelor' s Degree in Nursing

· Master' s Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field Preferred

 

Requirements-

· State RN State license with no restrictions are required for the job

· 3 + years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement

· Knowledge of medical terminology and/or experience with CPT and ICD-9 coding


Interested in setting up a phone interview screening? please contact Ashley Kruger at 877-782-3334 or email akruger@alinestaffing.com

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