participates in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences.
contributes to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
member outreach calls.
medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.
provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to close gaps.
quality document updates (example: quality improvement program description, work plans, and evaluation).
quality Improvement Committee meetings.
completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports).

3+ years of previous experience working with member outreach on quality and performance improvement activities.
2+ years previous experience in healthcare quality improvement/quality operations.
Knowledge of HEDIS/CMS/Quality.
Experience with healthcare quality measures (example HEDIS, CAHPS).
Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas).

Quality Compliance Professional

Key skills