Registered Nurse Clinical Quality Specialist
Job Summary
To support quality improvement initiatives, the full-time salaried Registered Nurse Clinical Quality Specialist will oversee performance improvement activities, ensure regulatory compliance, and assist with the HEDIS program while working remotely.
Key responsibilities
- Plan, design, implement, and maintain a comprehensive program for continuous quality improvement through HEDIS compliance tracking and analysis
- Assume accountability for HEDIS/Stars improvement activities, including medical record review and provider education to enhance compliance rates
- Evaluate reports and investigate potential quality of care issues to ensure compliance with clinical quality requirements
Required qualifications
- Current Registered Nurse license or multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC) with four years of healthcare clinical experience
- Bachelor's degree in healthcare or business-related field with six years of healthcare quality management or performance improvement experience
- Knowledge of CMS guidelines, NCQA, and HEDIS
- Experience with Quality Management, Quality Improvement, or Process Improvement
- Ability to analyze large data sets and provide actionable recommendations
Complete Job Description
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