HireDiversity

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: Charleston-West Virginia-United States,Richmond-Virginia-Unite