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Quality Performance Specialist Clinical

Company: Amerihealth
Location: Baton Rouge
Posted on: February 13, 2019

Job Description:

Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at . 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:

  • Registered Nurse with Cleqar/Active license in the state of Louisiana required.
  • 3-5 years quality improvement experience required.
  • 2-4 years experience in project facilitation/management role preferred.
  • 3 - 5 years Managed Care experience preferred.
  • Proficient with Microsoft Office applications including Word, PowerPoint, Excel required.
  • Knowledge and understanding of QI functions in an MCO preferred.
  • Knowledge of Medicaid and Medicare preferred.

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