Quality & HEDIS Specialist

Position Overview **NO REMOTE**

The Quality & HEDIS Specialist is responsible for overseeing all organizational risk functions, including event reporting, patient safety, complaint resolution, regulatory compliance, and risk‑related education. This role ensures the organization maintains a safe environment for patients and staff, complies with state and federal requirements, and proactively identifies and mitigates risk across all clinical operations.

Essential Duties & Responsibilities Event Reporting & Risk Analysis

· Serve as the Administrator for RL Solutions and oversee the full event reporting lifecycle.

· Review, investigate, and trend incident data to identify patterns and areas of concern.

· Develop and deliver risk education based on trended data.

· Prepare quarterly risk reports for the CEO and Governing Board.

· Conduct the annual evaluation of the Risk Management Plan and establish new goals based on findings.

Patient Complaints & Service Recovery

· Manage all “You Matter” phone calls and emails, ensuring timely follow‑up and resolution.

· Draft written responses to health plans regarding patient complaints.

· Maintain detailed logs of complaints, outcomes, and corrective actions.

· Round in offices when risk issues are identified to support staff and leadership.

Regulatory Compliance & Documentation

· Conduct medical record reviews when Notices of Intent are received.

· Maintain updated risk files for active and potential cases.

· Collaborate with Billing and Coding to ensure timely completion of medical records.

· Work with Compliance and physicians on amended medical record requests.

· Participate in policy and procedure development related to risk and patient safety.

Education & Training

· Administer annual company‑wide Risk Management training.

· Assist the Education Department with developing skills‑based competencies.

· Maintain updated competency forms based on changes to practice standards.

· Provide customer service and risk‑related training during new hire orientation.

Emergency Preparedness

· Serve as a member of the Hernando ESF‑8 Emergency Management working group.

· Chair the EOC Committee during inclement weather or emergency events.

· Coordinate communication and readiness activities across clinical sites.

Clinical & Operational Support

· Provide risk‑related guidance to physicians, COMs, and office staff.

· Respond to IPA Operations Managers when issues arise that involve risk or clinical concerns.

· Support offices with compliance audit corrective action plans.

· Collaborate with BluOne on risk software and educational video development.

QualificationsEducation & Certifications

· RN and clinical experience in hospitals or SNFS in risk management roles, quality assurance and supervisory role is required

Experience

· 3–5 years of experience in healthcare risk management, patient safety, or compliance.

· Experience with RL Solutions or similar event reporting systems.

· Strong understanding of clinical workflows and regulatory requirements.

Skills

· Excellent communication, investigation, and documentation skills.

· Ability to analyze data, identify trends, and develop corrective action plans.

· Strong organizational and time‑management abilities.

· Proficiency in MS Office and EMR systems.

Work Environment & Requirements

· Occasional travel to local offices for rounding and investigations.

· Must be able to sit, type, and use a computer for extended periods.

· Occasional lifting up to 10–25 lbs.

Pay: $87,289.60 - $105,122.96 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Medicare stars: 1 year (Preferred)
• HEDIS: 3 years (Required)
• Patient assessment: 1 year (Preferred)
• COMPLIANCE AUDIT: 1 year (Preferred)

License/Certification:

• RN License (Required)
• APRN (Preferred)

Work Location: In person

Salary : $87,290 - $105,123