Supervisor, Quality Management
About The Position
The Clinical Quality team oversees and is responsible for HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Supervisor will report to the Manager of the HEDIS Outreach Team. In this role, you will be primarily responsible for overseeing HEDIS pursuit activities in collaboration with the Manager and Sr. Manager. In addition, this role is responsible for overseeing member outreach activities for care gap closure as well as overseeing temp staff working in the Long Beach office. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Requirements
- Requires a bachelor's degree in Nursing, Public Health, or other related field
- Requires at least 7 years of prior relevant experience including 3 years of experience operating in a lead role
- Required knowledge of computer applications including Microsoft Word, PowerPoint and Excel, internet knowledge with the ability to complete searches
- Required communication and interpersonal skills
- Must be organized with the ability to keep accurate notes and records
- Required customer service experience
- Required HEDIS process and measure knowledge
- Required ability to lead a team
Responsibilities
- Provide specialized support and oversee project management for outreach initiatives, ensuring that all activities are executed efficiently and meet organizational goals
- Manage and troubleshoot outreach automation templates to streamline communication processes and maximize engagement
- Supervise HEDIS pursuit activities, including tracking and reporting progress to maintain compliance and achieve performance targets
- Oversee request medical records from primary care providers or specialists via fax or by scheduling site visits as necessary
- Manage and maintain HEDIS files and medical records, ensuring accurate and secure storage of documentation
- Research member claims and encounters to identify accurate pursuit information for medical record retrieval
- Assist in onboarding contingent workforce for HEDIS and outreach projects
- Continually monitor staff, adjusting assignments based on critical needs and project milestones
- Retrieve medical records remotely using EMR systems and vendor portals
- Conduct quality review and audit of outbound calls and documentation
- Perform quality review and audit of medical records submitted for clinical review
- Review medical records to identify elements necessary for compliance
- Other support as requested by leadership
- Capability to analyze and reorganize data effectively to support informed decision-making and ensuring the team can respond quickly to changing needs or priorities within outreach and HEDIS initiatives
- Provide training, mentorship and performance feedback for direct reports, including remote and/or in-office staff
- Implement quality improvement program strategies to improve HEDIS performance rates
- Adhere to Hybrid work policy based on job role, office distance and business needs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
