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HEDIS Specialist (Hybrid)
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- The primary function of the Clinical Quality Reviewer is to assess and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures and quality improvement activities.
- Additionally, participation in the annual HEDIS and QARR hybrid medical record review project will be required.
- Maintain up-to-date knowledge of HEDIS, QARR and Star specifications.
- Perform clinical audits via EMR, in-house paper medical records, on-site provider visits to measure compliance with preventive health guidelines and to measure effectiveness of quality improvement initiatives.
- Data enter accurate and timely clinical quality findings in the appropriate system(s) in accordance with established documentation standards for MetroPlus Health Plan to ensure integrity of member services provided over the continuum of care and over time.
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