Job Position: Quality Improvement Specialist (RN / LCSW)Location: Westmont, IL 60559Pay Rate: $40-42/hourSchedule: M-F, 8 AM - 4:30 PMDescription: Perform quality improvement activities including, but not limited to, member and or provider outreach and or education, care gap closure documentation, medical record data abstraction and over-reads of HEDIS and other quality related measures
- Conducts member and/or provider outreach to close quality care gaps for Medicare , Medicaid, and Marketplace Quality measures.
- Coordinates and facilitates member access to various healthcare providers for services, as necessary.
- Enters pertinent clinical information into various medical management systems.
- Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
- Educates providers on HEDIS measures and documentation requirements based on provider medical records
- Collects and summarizes performance data and identifies opportunities for improvement to educate providers and improve overall quality metric performance.
- Monitors HEDIS quality improvement initiatives that may include development and implementation of preventive health and chronic disease outcome improvement interventions such as: newsletter articles, member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys. May perform data abstraction and or over-reads for HEDIS Hybrid quality measures.
- Performs other duties as assigned.
Education/Experience:
- Graduate from an Accredited School of Nursing (Registered Nurse), required OR Bachelor's Degree Bachelor's degree in social work, counseling, healthcare or related field, required.
- HEDIS knowledge and experience.
- Member intervention and outreach experience
- Active and in good standing: Licensed Clinical Social Worker (LCSW) or a Registered Nurse (RN) required.
- Current state driver's license.
AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.