West Virginia Licensed Clinical Quality Specialist

Job Summary

A company is looking for a Clinical Quality Specialist to oversee performance improvement activities and ensure regulatory compliance.

Key Responsibilities

• Plan, design, implement, and maintain a continuous quality improvement program through HEDIS compliance tracking and analysis
• Assume accountability for HEDIS/Stars improvement activities, including medical record review and provider education
• Review medical records to ensure quality care and maintain compliance with clinical programs and standards

Required Qualifications

• Current unencumbered licensure as a Registered Nurse or multi-state licensure through the enhanced Nurse Licensure Compact, with four years of clinical experience
• Bachelor's degree in healthcare or business-related field with six years of healthcare quality management experience
• Knowledge of CMS guidelines, NCQA, and HEDIS
• Experience with quality management or performance improvement in healthcare settings
• Ability to analyze large data sets and provide actionable recommendations