Quality Metrics Specialist-Health Plan

Cook Children's Health Care System • Remote - TX, TX

2d • Remote

About The Position

Responsible for implementing processes in the Quality Improvement department regarding project management, and quality improvement within a managed care organization. Responsibilities include monitoring, tracking, trending, analyzing, and reporting all data, performance measures, and other required information requested by the Health and Human Services Commission (HHSC), Centers for Medicare and Medicaid Services (CMS), Texas Department of Insurance (TDI), National Committee for Quality Assurance (NCQA) or any other accrediting or regulatory bodies. Monitors data and action plans as they relate to HEDIS or other projects/programs overseen by the Quality Improvement department. Coordinates cross-functional efforts internally and externally as needed to support HEDIS data collection, validation and other assigned projects. Supports the department with the collection and analysis of related data/information and in the development of strategies/processes to improve performance outcomes.

Requirements

• High School Diploma or equivalent is required.
• Health Plan Claims or Clinical experience required
• Requires moderate to expert experience with computer programs, including Microsoft Office programs (Word, Excel, and PowerPoint).
• Licensed Vocational Nurse or Registered Nurse

Nice To Haves

• Bachelor's degree (B.S.) from four-year college or university preferred.

Responsibilities

• Monitoring, tracking, trending, analyzing, and reporting all data, performance measures, and other required information requested by the Health and Human Services Commission (HHSC), Centers for Medicare and Medicaid Services (CMS), Texas Department of Insurance (TDI), National Committee for Quality Assurance (NCQA) or any other accrediting or regulatory bodies.
• Monitoring data and action plans as they relate to HEDIS or other projects/programs overseen by the Quality Improvement department.
• Coordinating cross-functional efforts internally and externally as needed to support HEDIS data collection, validation and other assigned projects.
• Supporting the department with the collection and analysis of related data/information and in the development of strategies/processes to improve performance outcomes.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED