Quality Performance Specialist Clinical (New Hampshire)

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 preferred
• 3-5 years Managed Care experience required
• 3-5 years quality improvement experience required.
• 2-4 years experience in project facilitation/management role.
• 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.