The Clinical Quality Improvement Liaison is responsible for managing HEDIS and Stars performance by working with low performing providers to identify areas of opportunity. The CQA will be the main Quality contact for providers, they will provide guidance and resources in order for the provider to achieve target Quality Performance metrics, as established by the National Committee for Quality Assurance.
- 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, aid 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
- Ability to make sound decisions with or without the input of Administrators.
- Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
- Strong interpersonal skills and the ability to build relationships with stakeholders, including staff, board members, external partners and donors.
- Demonstrated proactive approaches to problem-solving.
- Emotional maturity.
- Highly resourceful team-player, with the ability to also be extremely effective independently.
- Proven ability to handle confidential information with discretion, be adaptable to various competing demands, and demonstrate the highest level of customer/client service and response.
- Demonstrated ability to achieve high performance goals and meet deadlines in a fast-paced environment.
- Forward looking thinker, who actively seeks opportunities and proposes solutions.
Education and Experience Requirements
- 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
- Prefers experience in continuous quality improvement and/or quality management.