What are the responsibilities and job description for the Quality Improvement Specialist position at medstar?
Accountable for continuous systematic monitoring of all MedStar Family Choice (MFC) network participating provider processes and outcomes. Responsible for the quality oversight of assigned delegated entities which must meet the established standards set by the State,and NCQA. Actively participates in special quality projects. Actively participates and conducts quality audits; i.e. HEDIS, NCQA, and the External Quality Review Organization (EQRO). Coordinates and conducts medical record reviews and abstracts data. Records information in the Care Management Platform and hybrid record capture tool for HEDIS. Must maintain a minimum of 95% data entry accuracy for auditing purposes. Data entry accuracy is a critical function as errors can result in a non-report for the HEDIS care measure impacting the HEDIS rate and NCQA rating. Contacts members to educate them about wellness initiatives that align with the State of Maryland's Value Based Purchasing initiatives, HEDIS standards and Performance Improvement Projects. Accountable for all contact and following through with member's primary care provider or specialist. Responsible for the completion and notification of MCO members identified with HIV and AIDS to the Maryland Department of Health (MDH). Coordinates the quality and performance improvement of MFC providers through onsite delivery and education of provider reporting on HEDIS measures and Performance Improvement projects.
We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.
