Quality Metrics Specialist-Health Plan

Location:

Remote - TX

Department:

Quality

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

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.

Additional Information:

The Quality Metrics Specialist is 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.

Education and Experience

• High School Diploma or equivalent is required.

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

• Health Plan Claims or Clinical experience required

• Requires moderate to expert experience with computer programs, including Microsoft Office programs (Word, Excel, and PowerPoint).

Licensure, Registration, and/or Certification

• Licensed Vocational Nurse or Registered Nurse

About Us:

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.