Clinical Qual Imprv Liaison

Requires Bachelor’s degree from an accredited college or university, preferably in Healthcare or related field. In lieu of degree applicant must have an additional 3 years of equivalent and relevant work experience.
Requires a minimum of three (3) years experience in a healthcare setting: health plan, hospital, physician practice, or managed care organization

Primary liaison for the Quality Management department and all assigned provider groups to improve HEDIS and Stars Quality Performance.
Monitor and analyze provider Quality Performance Reports. Identify areas of improvement, provide assistance with root cause analysis, assists with developing solutions, and develop a work plan to monitor progress.
Conduct on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation.
Collaborate with Value Based Programs and Provider Contracting and Services to manage provider quality performance.
During HEDIS season, assists with the retrieval of charts, chart abstraction, and chart review entries. CQM must adhere to the HEDIS guidelines for chart review abstractions and standards.
Provide HEDIS provider guidelines that highlight appropriate HEDIS codes for claims submission.
Assists in the development of member and provider outreach, engagement, and education materials to improve Quality Performance.
Completes other assigned functions, including special projects, as requested by management.
Conducts training for new and current staff on processes that will result in improving HEDIS and Stars Quality Performance.
Creates and updates processes, work plans and policies.
Aggregate monthly project performance metrics.

Prefers experience in continuous quality improvement and/or quality management.
No Regulatory Requirement; Active Unrestricted NJ Clinical License Preferred.
Prefers knowledge of Population Health Management and Preventative Management Programs.
Prefers Project Management skills.