Quality Performance & Initiatives, Professional, Clinical Quality #895
MVP’s Quality department focuses on improving the clinical well-being of MVP members by focusing on improving key metrics of care. The Quality department is seeking a highly driven, curious, and detail-oriented candidate for the position of Clinical Quality Professional. This position will direct report to the Leader, HEDIS Data Management and be responsible for providing quality measure clinical expertise in support of HEDIS and overall quality improvement efforts. Specifically, this role will support:
- Annual collection, review, and validation of gaps in care data, and evaluate ROI on previous year efforts to ensure MVP is collecting the correct data to optimize measurement of compliance.
- Review of supplemental data includes logging and providing feedback to providers on the results of medical record reviews. Works directly with an individual provider/practitioner to facilitate performance improvement in the provider office setting.
- Defining chart chase logic, volume, and prioritization of measures in support of HEDIS Medical Record Review process
- Defining and monitoring key metrics around measure compliance progress and the Medical Record Review process
- Conducting clinical quality review and medical record abstraction for MVP’s regulatory required medical record reviews
- Reviewing training materials and measure criteria for HEDIS Vendor, and various MVP outreach staff
- Working with Quality Initiatives team to support clinical quality interventions and innovations
- Collaboration with internal business partners to facilitate and leverage access to provider data. For example, Risk Adjustment, Provider Relations, Networks, Case Management, etc.
- Establishing and maintaining connections to various remote access sites to enable MVP to obtain EHR records for HEDIS Chart Collection
- Adoption of electronic clinical data by supporting provider partners in optimizing record keeping
- Other duties as assigned
Current New York State license as an LPN. Registered Nurse preferred
Experience in review of clinical documentation and medical records.
Previous HEDIS Measure subject matter expertise.
Five years of varied work experience in clinical services preferred.
- Excellent clinical assessment and decision-making skills as demonstrated by the ability to readily abstract pertinent clinical information from the review of a wide range of medical records.
- Exemplary attention to detail and completeness.
- Must meet pre-established thresholds for clinical review post-training testing.
- Ability to work effectively and collaboratively in a team environment.
- Ability to maintain a professional demeanor in dealing with providers/practitioners in potentially difficult situations.
- Ability to effectively (clearly and concisely) communicate review findings to providers/provider office staff.
- Ability to maintains the confidentiality of providers/practitioners, and members.
- Strong organizational ability to manage projects with tight timelines.
- Computer Skills: Proficient in the use/application of Microsoft Office (Word, Excel).
- Valid New York State Driver’s license and access to a motor vehicle.
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at email@example.com
Please apply and learn more – including how you may become a proud member of our team.