Role Description
Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI). Assists in educating new staff, providers about the quality improvement (QI) systems and requirements.
• Knowledge of quality improvement principles, practices, and procedures.
• Oversees complex HEDIS project lifecycles—including data analysis, medical record abstraction, chase logic.
• Thorough knowledge of Performance Improvement Projects (PIPs) and able to apply that knowledge in PIP writing development, update, and analysis of data in PIPs.
• HEDIS experience, planning of the whole HEDIS project from start to end, understanding the process and planning of medical record review and abstraction.
• Must be able to analyze HEDIS data to develop interventions for gaps in care.
• Maintains deep working knowledge of URAC/NCQA standards, the Uniform Managed Care Contract, and state-specific programs like Texas Health Steps and Alternative Payment Models.
Qualifications
• Licensure / Certification / Registration:
• Certification specializing in Lean Healthcare Mgmt preferred.
• Licensure required relevant to state in which work is performed.
• Project Mgmt Professional preferred.
• Registered Nurse preferred.
• Education:
• High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job-specific experience required.
Requirements
• Bachelor's Degree in Nursing is a must-have.
• 2+ years of Registered Nurse (RN) experience.
• 2+ years of HEDIS experience.
• Performance Improvement Projects (PIP).
• Must reside in Texas.
Benefits
• Paid time off (PTO).
• Various health insurance options & wellness plans.
• Retirement benefits including employer match plans.
• Long-term & short-term disability.
• Employee assistance programs (EAP).
• Parental leave & adoption assistance.
• Tuition reimbursement.
• Ways to give back to your community.