Clinical Quality Performance Specialist

Job Description

Job Description

Company Overview:

As one of the Washington Metropolitan-area’s fastest growing IT companies, we are always looking for creative, passionate and responsible employees. We acknowledge that intelligent, dedicated employees are our greatest asset and are continuously adding to our talented and diverse team. If you feel innovation, integrity and a drive to deliver are key components to success, we invite you to become Enlightened.

Position Overview:

The Clinical Quality Performance Specialist is responsible for completing the clinical quality review process. With a focus on ensuring standards of care are met, this position is poised to lead improvement efforts through data analysis, provider partnership, and program development. This role is for individuals who thrive in the complexity of the healthcare environment, yet ready to be part of the systemic change needed to ensure quality and equity in care are connected and aligned.

The ideal candidate must be a Registered Nurse (RN) with an active license to practice in Washington, DC.

Position Responsibilities:

• Complete the clinical quality review process.
• Assist in Quality Management initiatives including data collection and analysis
• Participate in activities to maintain compliance with state regulations and NCQA standards for quality activities
• Participate in the implementation of clinical and service quality improvement studies and performance improvement initiatives
• Supporting the annual medical record review activities including but not limited to HEDIS and Encounter Data Validation.
  

Required Qualifications:

• Bachelor’s Degree in a healthcare-related field (preferred)
• 3-5 years of clinical healthcare experience (required)
• 2 years of quality improvement experience (preferred)

License/Certification/Registration:

• RN License (District of Columbia) (required)

Knowledge, Skills, and Abilities:

• Effective verbal and written communication skills
• High degree of computer proficiency, particularly with Microsoft Office applications: Word, PowerPoint, Excel
• Ability to establish priorities in a fast-paced and innovative environment, work independently, be self-motivated, goal-oriented, and solution-focused
• Experience in project facilitation and management (preferred)
• Knowledge and understanding of QI functions in an MCO (preferred)
• DC residency (preferred)

Benefits:

The expected salary range for this position is listed above. Actual compensation will be determined based on experience and qualifications as well as internal equity and alignment with market data.

At Enlightened, we pride ourselves on offering a comprehensive and industry-competitive benefits package to our full-time employees. Our benefits include:

• Medical/Dental/Vision Insurance with Health Savings Accounts (HSA)
• Flexible Spending Accounts (FSA)
• 401(k) Retirement Plan
• Paid Holidays, Vacation, & Sick Leave
• Professional Training & Development Reimbursement

Please note, these benefits are available exclusively to full-time employees of Enlightened.

Enlightened is proud be an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.