Clinical Quality Improvement Specialist

Job Description:

The Clinical Quality Improvement Specialist utilizes the NCQA HEDIS Technical Specifications to perform accurate and timely medical record abstraction, auditing, and monitoring of data from health information records.



Support abstraction activities (e.g., regulatory and accreditation required registries, approved databases supporting clinical program, clinical services, clinical lane registries, and health plan portals).

Provides critical analysis of HEDIS requirements and technical specifications to ensure compliance and participation, serving as a subject matter expert on HEDIS compliance for the organization.

Assists in developing and implementing the organization’s quality improvement activities related to patient gaps in care closure, database integrity, and registry outputs to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other identified performance measures.

Contacts patients and provider offices to obtain follow up data not found in the health record, such as diagnostic testing performed at external facilities.

Minimum Qualifications

• Demonstrated previous healthcare experience, preferably in a managed care environment.
• Demonstrated intermediate skills in word processing, spreadsheet, and database software
• Demonstrated successful collaboration with internal and external colleagues and customers
• Ability to understand technical information
• High level project management skills, excellent organizational ability, and good written communication skills

Preferred Qualifications

• Bachelor's degree from an accredited institution (degree will be verified).
• 2 years working with HEDIS, Center for Medicare and Medicaid Services (CMS), and other state and federal regulatory or managed care environment.
• HEDIS Reporting and data collection experience
• Project management experience in healthcare
• Knowledge of CPT and ICD10 coding

Physical Requirements:

Location:

Nevada Central Office

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

$27.65 - $43.55

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.