Clinical Quality Specialist
Job Summary
To ensure compliance and data integrity, the full-time Clinical Quality Specialist will perform HEDIS medical record reviews, data abstraction, and validation activities, working in a hybrid model of remote and onsite at 100 Church Street, New York, NY.
Key responsibilities:
- Conduct HEDIS medical record reviews and data validation in accordance with NCQA guidelines
- Collaborate with providers and internal departments to ensure compliance with regulatory standards
- Identify and resolve data discrepancies while maintaining audit readiness and supporting quality improvement initiatives
Required qualifications:
- Bachelor's degree in Nursing, Public Health, Health Administration, or a related field
- Minimum of one year of experience in healthcare quality, HEDIS operations, or healthcare analytics
- Knowledge of HEDIS measures and clinical documentation standards
- Familiarity with EMR systems and data abstraction tools
- Proficiency in Microsoft Office applications, particularly Excel
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