Provider Clinical Quality Specialist

Primary Responsibilities

• Research, analyze, and document clinical best practice guidelines and related quality measures which align with evidence-based best practice guidelines and value-based reimbursement models.
• Document technical specifications related to specific quality measures to be used internally for data reporting and externally for transparency with Network Providers.
• Present actionable data to network providers, sharing current quality performance scores against expectations and identifying opportunities for improvement.
• Maintain knowledge of relevant provider quality initiatives and value-based reimbursement models such as Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Bundled Payment for Care Improvement (BPCI) and Physician Quality Reporting System (PQRS).

Requirements

• Bachelor’s degree in nursing and R.N. licensure that is unrestricted in the state of Mississippi, or advanced practice degree.
• Three years’ healthcare clinical experience as a nurse or nurse practitioner.
• Skilled in implementing focused activities for monitoring/improving health-related outcomes.
• Proficient in presenting data in an appropriate and actionable manner, confidently advocating for the best practice quality model of care.

Qualifications

• Intermediate proficiency utilizing software in the Microsoft Office Suite, specifically Word and Excel.
• Ability to work a flexible schedule when required with limited or frequent travel.

Preferred

• Master’s degree in nursing or healthcare administration.
• Comprehensive understanding of Women’s Health and Obstetrics Care Best Practices.
• Intermediate proficiency with Microsoft Access and Visio.
• Practical knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Tenth Revision (ICD10), Uniform Billing (UB) Revenue and National Drug Code (NDC) coding.
• Data interpretation and statistical analysis for healthcare related trends.
• Solid understanding of value-based programs such as Bundled Payments for Care Improvement (BPCI) and Physician Quality Reporting System (PQRS).
• Working knowledge of accreditation programs such as Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and National Committee for Quality Assurance (NCQA).

Benefits

A comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field.