Clinical Quality Specialist RN - Peak Health

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. The Clinical Quality Specialist will be an integral member of the Peak Health ’s quality team. This position is responsible for overseeing performance improvement activities, ensuring regulatory compliance, and other initiatives that lead to effective improvements in quality. In this role you will support the HEDIS program by assisting with medical record retrieval and abstraction, working closely with providers to ensure accurate and complete documentation and collaborating with the HEDIS Program Manager and Quality Manager to implement performance improvement initiatives. Additionally, the Clinical Quality Specialist will be involved in performance monitoring and assessment and gathering and analyzing data to evaluate outcomes. MINIMUM QUALIFICATIONS: EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE: 1. Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC) AND Four (4) years of healthcare clinical experience OR Bachelor’s degree in healthcare or business-related field AND Six (6) years healthcare quality management or performance improvement in a health plan, hospital, or physician practice. PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion within three (3) years of hire. EXPERIENCE: 1. Managed Care knowledge or experience 2. Three (3) years Quality Management, Quality Improvement or Process Improvement Experience. 3. Knowledge of CMS guidelines, regulations, NCQA® and HEDIS®. 4. Thorough knowledge of