Clinical Quality Specialist I - R3039-6334

This job was posted by https://idahoworks.gov : For more information,please see: https://idahoworks.gov/jobs/2346605 Blue Cross of Idaho isseeking a Registered Nurse who wants to improve the lives of Idahoansthrough continuous quality improvement. The Clinical Quality Specialistrole is responsible for evaluating Quality of Care concerns, HEDISimprovement efforts, year round data abstraction, training HEDIS nurseabstractors for the annual audit, developing interventions to improvethe health of our communities. The Clinical Quality Specialist worksdaily with a team of clinical and non-clinical staff.We're looking for Clinical Quality Specialist with:Experience: 3 years' clinical experience in a health plan and/orhealth care settingEducation: Associates Degree in Nursing; or equivalent workexperience (Two years' relevant work experience is equivalent toone-year college)Licenses/Certifications:Valid unrestricted Idaho Registered Nursing LicensePreferred Qualifications:
• Bachelors in Nursing
What a day would look like:
• Develop training materials and successful training plan for the
annual HEDIS audit and HEDIS Nurse Abstractors
• Performs medical record review for select HEDIS measures using
technical specifications provided by NCQA to ensure compliance andvalidity of the abstracted data.
• Serve as a clinical resource to the Quality Management team
• Investigate and prepare Quality of Care concerns for review with
clinical team, leadership and in some cases, appropriate committeesto determine final leveling of care provided to BCI members
• Review Hospital Acquired Conditions (HAC) report and identify
Quality of Care concerns
• Performs root cause analysis when compliance, accreditation or
clinical gaps are identified and provides results to leadership.
• Develop and maintain Quality Improvement Plans to support regulatory
requirements and development and implementation of corrective actionplans when necessary
• Collaborate with the Quality Management team to identify and
implement interventions that will improve HEDIS rates and memberoutcomes
• Ensures effective workflows, maximizes system efficiencies, and
monitors quality performance measures; makes recommendations forchange as appropriate.
• Review and update policies
• Performs other duties as assigned
As of the date of this posting, a good faith estimate of the current payrange is $71,708 to $100,391. The position is eligible for an annualincentive bonus (variable depending on company and employee performance.The pay range for this position takes into account a wide range offactors including, but not limited to, specific competencies, relevanteducation, qualifications, certifications, relevant experience, skills,seniority, performance, shift, travel requirements, internal equity,geography, business or organizational needs, and alignment with marketdata. At Blue Cross of Idaho, it is not typical for an individual to behired at or near the top range for the position. Compensation decisionsare dependent on factors and circumstances at the time of offer.We offer a robust package of benefits including paid time off, paidholidays, community service and self-care days,medical/dental/vision/pharmacy insurance, 401(k) matching andnon-contributory plan, life insurance, short and long term disability,education reimbursement, employee assistance plan (EAP), adoptionassistance program and paid family leave program.We will adhere to all relevant state and local laws concerning employeeleave benefits, in line with our plans and policies.Reasonable accommodationsTo perform this job successfully, an individual must be able to performeach essential duty satisfactorily. The requirements listed above arerepresentative of the knowledge, skill and/ r ability required.Reasonable accommodations may be made to enable individuals withdisabilities to perform the essential functions.We are an Equal Opportunity Employer and do not discriminate againstany employee or applicant for employment because of race, color, sex,age, national origin, religion, sexual orientation, gender identity,status as a veteran, and basis of disability or any other federal, stateor local protected class.

About the Company:
Blue Cross of Idaho

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