HEDIS Performance Improvement Specialist
**Details**
+ **Department:** Ascension Care Management Insurance- Total Quality Management
+ **Schedule:** Full-Time, 8-hour Day Shift, Monday-Friday, Remote
+ **Facility:** Remote- Must reside in Texas
+ **Salary:** $75,295.00 - $104,957.00 (per year)
+ Eligible for an annual bonus incentive
**Benefits**
+ **Comprehensive health coverage:** medical, dental, vision, prescription coverage and HSA/FSA options
+ **Financial security & retirement:** employer-matched 403(b), planning and hardship resources, disability and life insurance
+ **Time to recharge:** pro-rated paid time off (PTO) and holidays
+ **Career growth:** Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
+ **Emotional well-being:** Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
+ **Family support:** parental leave, adoption assistance and family benefits
+ **Other benefits:** optional legal and pet insurance, transportation savings and more
_Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process._
**Responsibilities**
A Performance Improvement Specialist facilitates the development and definition of ideas that will improve the organization. This role supports the DCHP's quality improvement programs and coordinates quality management efforts, including development, implementation, data collection, and analysis.
+ Extensive working knowledge of HEDIS, with proven experience and knowledge of quality improvement principles, practices and procedures.n planning and managing the entire HEDIS project lifecycle.
+ Demonstrated working knowledge of the HEDIS Roadmap completion process.
+ Skilled in HEDIS data analysis to identify and create interventions for care gaps.
+ Knowledgeable in the planning and process of medical record review and abstraction.
+ Knowledge of the chase logic used in medical record review.
+ Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI). Assists in educating new staff, providers about the quality improvement (QI) systems and requirements.
+ Knowledge of quality improvement principles, practices and procedures.
+ Deep understanding of Performance Improvement Projects (PIPs) and proven capability in their development, documentation (writing), maintenance (updates), and data analysis.
+ Analyze medical records and supporting documentation to verify quality of care.
+ Assist in preparing the annual QI evaluation report and plan/program documents.
+ Possess working knowledge of the Uniform Managed Care Manual, Uniform Managed Care Contract, URAC/NCQA standards, and the ability to apply these concepts effectively to daily tasks.
+ Possesses working knowledge of the following quality programs: Alternative Payment Models, Pay for Quality, and Texas Health Steps, with the ability to apply this knowledge to the required implementation, monitoring, and calculations for each.
+ Possesses the maturity, sound judgment, experience, and confidence to practice independently in challenging and diverse situations.
+ Communicate ideas clearly, concisely, and coherently. Apply balanced judgment when evaluating situations and making decisions.
+ Demonstrated ability to remain resourceful and calm while managing multiple competing initiatives, deadlines, and deliverables, particularly during process build-out.
**Requirements**
Licensure / Certification / Registration:
+ Certification specializing in Lean Healthcare Mgmt. preferred.
+ Project Mgmt Professional preferred.
+ Registered Nurse preferred.
+ Registered Nurse credentialed from the Texas Board of Nursing preferred.
Education:
+ High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required.
**Additional Preferences**
Additional preferences:
+ Bachelor's Degree in nursing or other health science degree, a must have.
+ 2 years of registered nurse experience, preferred.
+ 2 years of HEDIS experience, preferred.
+ Skilled in building and managing collaborative relationships, and coordinating initiatives across internal teams and outside groups, a must have.
+ Strong communication skills for responding effectively to all internal and external inquiries and complaints, a must have.
\#LI-Remote
**Why Join Our Team**
Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.
**Equal Employment Opportunity Employer**
Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) (https://www.eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRights6.12.pdf) poster or EEO Know Your Rights (Spanish) (https://www.eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRightsSp6.12.pdf) poster.
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**_E-Verify statement_**
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