We have partnered with a large Health Insurance company in the Washington, DC area to provide them with a Quality Performance Specialist Clinical, RN.

Please review the below description and if you are interested please contact:

• Phanish Adivi at (e-mail removed), 484-403-4161

Job Summary:

Responsibilities:

This position is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing of care standards. In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and, Clinical Practice Guidelines. The position also supports accreditation and clinical quality performance improvement activities.

Education/Experience:

• Required Registered Nurse with current and valid licensure in Washington DC.


• Required Proficient with Microsoft Office applications including Word, PowerPoint, Excel.


• Required 3-5 years quality improvement experience.


• Preferred CPHQ.


• Preferred knowledge and understanding of QI functions in an MCO (link removed)>
  
• Preferred knowledge of Medicaid.


• 2-4 years experience in project facilitation/management role.


• 3 –5 years Managed Care experience.