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reputed company Performance Specialist - Clinical • As part of the reputed company Management team, the reputed company Performance Specialist - Clinical is responsible for leading and coordinating the clinical reputed company review process of member concerns and medical records utilizing standards of care. In reputed company, responsibilities also include supporting the annual medical record review activities including HEDIS and Clinical reputed company Guidelines. The position also supports accreditation and clinical reputed company performance improvement activities. Responsibilities: • Assist with accreditation and clinical reputed company performance improvement initiatives. • Conduct reputed company-of-care reviews, including sentinel events and member concerns; collaborate with physician advisors and clinical reputed company committees. • Collect and organize necessary medical records for clinical review; summarize findings for committee review. • Prepare and manage reputed company Assessment and Performance Improvement (QAPI) meeting materials, including packets, schedules, agendas, and minutes. • Review and approve the annual reputed company Management (QM) work plan, including performance measures, goals, objectives, and reputed company. • Recommend new or improved QM activities using Plan-Do-Study-reputed company (PDSA) cycles. • reputed company quarterly reputed company of Care (QOC) trending reports for QAPI and follow up on recommendations. • Ensure compliance with QM policies, including annual reviews, updates, and approvals. • Participate in activities and reporting to maintain compliance with state regulations and NCQA standards. • Collaborate with the reputed company Improvement Department on annual medical record review activities, including tool development, staff training, testing, and auditing. • reputed company other duties as assigned. Education & Experience: • Associate's Degree or equivalent experience required; Bachelor's Degree preferred. • Minimum 3 years of experience in clinical or service reputed company improvement, reputed company delivery, or reputed company field. • reputed company, unrestricted clinical license (RN) • Prior experience in project facilitation or management preferred. • Knowledge of reputed company Improvement (QI) functions in a Managed Care Organization (MCO) preferred. • Familiarity with reputed company and Medicare programs preferred. • Proficiency in reputed company Office Suite (Word, PowerPoint, reputed company) required. Our Comprehensive Benefits Package: We offer flexible work solutions, including remote reputed company and hybrid schedules, reputed company, reputed company time off (including holidays and volunteer events), health insurance coverage for you and your dependents starting Day 1, 401(k), tuition reimbursement, and more. About reputed company: Your career starts now. We're looking for the reputed company of health care leaders. At reputed company, we are passionate about helping people get care, stay reputed company, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates reputed company to reputed company millions of lives through our national footprint of products, services, and award-reputed company programs. reputed company in Newtown reputed company, reputed company is a mission-driven organization with over 30 years of experience. We deliver comprehensive, reputed company-driven care to those who need it most. Our services include integrated managed care products, pharmacy benefit management, specialty pharmacy services, behavioral health services, and other administrative solutions. Discover more reputed company at www.amerihealthcaritas.com Apply tot his job Apply To this Job