Description:
GENERAL SUMMARY
Responsible for performing in a consultative style and developing prospectively,
a conceptual framework for coaching Coventry health plans in the management of
HEDIS medical record review projects. Sets standards that are compatible with
NCQA, CMS and state Medicaid requirements for HEDIS reporting. Has sole
responsibility for some small to medium size analytical projects.
ESSENTIAL RESPONSIBILITIES
- Uses knowledge of HEDIS medical record project management to share best practices
with Coventry health plans and identify opportunities for improvement in local
medical record review strategies.
- Assists in translating needs, issues, and ideas into effective strategies and
action plans. Coordinates team/project activities and schedules. Synthesizes
analysis and identifies key findings.
- Communicates results/recommendations to project sponsors. Develops creative
alternative solutions. Recommends action steps to team and client. Plans and
facilitates meetings. Makes formal presentations.
- Uses application skills for managing medical record projects in Quality Spectrum
Hybrid Reporter (QSHR) and QSI applications. Provides technical assistance and
training to plans and other users on technical aspects and underlying concepts.
- Develops policies, procedures and guidance on medical record review and project
standardization.
- Provides consultation on effective use of local staff, temporary/seasonal staff and/or
medical record review vendors, as applicable.
- Frequent travel to local health plans is required.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience. Master’s degree preferred.
- Significant experience (usually 7-10years) in HEDIS medical record review and HEDIS
project management
- Demonstrated ability to conduct and interpret quantitative/qualitative
analysis.
- Experience in HEDIS medical record review and reporting software, preferably Catalyst/MedAssurant.
- Substantive knowledge of managed care operations. Excellent clinical knowledge
and skills.
- Strong written and verbal communication skills.
This position requires excellent verbal and written communication, analytical
and report writing skills; proficiency with spreadsheet software, specifically
Microsoft Excel and the ability to work in a fast paced environment.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: St. Louis, MO, US
Other Locations: Richmond-Virginia-United States,Omaha-Nebraska-United States,Kansas City-Missouri-United States,Metairie-Louisiana-United States,Wichita-Kansas-United States,Champaign-Illinois-United States,Urbandale-Iowa-United States,Atlanta-Georgia-United States,-Sunrise-Florida-United States,
Organization: 10900 - CMS - STAR Corporate
Schedule: Full-time
Job Posting: 2013-05-16 00:00:00.0
Job ID: 1212046
GENERAL SUMMARY
Responsible for performing in a consultative style and developing prospectively,
a conceptual framework for coaching Coventry health plans in the management of
HEDIS medical record review projects. Sets standards that are compatible with
NCQA, CMS and state Medicaid requirements for HEDIS reporting. Has sole
responsibility for some small to medium size analytical projects.
ESSENTIAL RESPONSIBILITIES
- Uses knowledge of HEDIS medical record project management to share best practices
with Coventry health plans and identify opportunities for improvement in local
medical record review strategies.
- Assists in translating needs, issues, and ideas into effective strategies and
action plans. Coordinates team/project activities and schedules. Synthesizes
analysis and identifies key findings.
- Communicates results/recommendations to project sponsors. Develops creative
alternative solutions. Recommends action steps to team and client. Plans and
facilitates meetings. Makes formal presentations.
- Uses application skills for managing medical record projects in Quality Spectrum
Hybrid Reporter (QSHR) and QSI applications. Provides technical assistance and
training to plans and other users on technical aspects and underlying concepts.
- Develops policies, procedures and guidance on medical record review and project
standardization.
- Provides consultation on effective use of local staff, temporary/seasonal staff and/or
medical record review vendors, as applicable.
- Frequent travel to local health plans is required.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience. Master’s degree preferred.
- Significant experience (usually 7-10years) in HEDIS medical record review and HEDIS
project management
- Demonstrated ability to conduct and interpret quantitative/qualitative
analysis.
- Experience in HEDIS medical record review and reporting software, preferably Catalyst/MedAssurant.
- Substantive knowledge of managed care operations. Excellent clinical knowledge
and skills.
- Strong written and verbal communication skills.
This position requires excellent verbal and written communication, analytical
and report writing skills; proficiency with spreadsheet software, specifically
Microsoft Excel and the ability to work in a fast paced environment.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: St. Louis, MO, US
Other Locations: Richmond-Virginia-United States,Omaha-Nebraska-United States,Kansas City-Missouri-United States,Metairie-Louisiana-United States,Wichita-Kansas-United States,Champaign-Illinois-United States,Urbandale-Iowa-United States,Atlanta-Georgia-United States,-Sunrise-Florida-United States,
Organization: 10900 - CMS - STAR Corporate
Schedule: Full-time
Job Posting: 2013-05-16 00:00:00.0
Job ID: 1212046