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Quality Clinical Management Lead Analyst
Ref No.: 19-07581
Location: Houston, Texas
Quality Clinical Management Lead Analyst
Pay: $26-36/hr.
Schedule: Mon-Fri 8:00am-5:00pm
Contract: 12/02/2019 - 4/30/2020
Location: 2800 North Loop West Houston, TX 77092 OR 500 Great Circle Road Nashville, TN 37228

Position is responsible for conducting the functions of Quality Management in a timely, efficient manner and ensuring achievement of QM objectives.

Specific responsibilities include, but are not limited to:
  • Reviews potential quality of care (QOC) cases including medical record reviews.
  • Prepares summary of findings, assigns level to case, and prepares resolution letter to customer.
  • Prepares and sends corrective action plans in collaboration with Medical Directors.
  • Prepares case studies for presentation to Physician Advisory Committee (Client).
  • Assists with preparation of and may present quarterly PQOC reports to Corporate Quality Improvement Committee (CQIC) and Client.
  • Defines and documents policies, procedures and processes related to QOC.
  • Interacts with Grievance Administration Division on identification and resolution of issues related to QOC complaints.
  • Identifies actions required to improve performance and work with regional and national teams to improve results.
  • May assist in the preparation, management and presentation of other Quality activities and reports including submission of all compliance related documentation.
  • Creates and maintains quality management files.
  • Ability to read and understand complex medical records including treatment plans, medication records, surgical notes, physician and nursing notes and any relevant clinical documentation pertaining to a quality of care concern.
  • Ability to write concise summary of clinical treatement and/or problem.
  • Ability to work independently as a member of the QOC team.
  • Candidates should have strong project management, research and analytical skills.
  • Knowledge/experience in the Medicare/Medicaid industry preferred.
  • Three to five years of quality review and improvement experience preferred.
  • Experience with NCQA standards, HEDIS, CAHPS, HOS and quality management preferred.
  • High School Diploma Required
  • Candidates must have a current LVN/LPN/RN license
  • RN license is strongly preferred
  • B.S. degree required or equivalent work experience in lieu of a degree.
  • English Read Write Speak