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QA Specialist Licensed Practical Nurse (LPN) - Work from Home (Southwest PA)
Job SummaryResponsible for managing annual and proactive HEDIS (PAH) for compliant/ non-compliant population, Health Choices/Commercial prenatal-postpartum (PNPP) population as assigned. Responsible for and evaluated against success with outreach to assigned HEDIS/PNPP member case load. Responsible for retrospective medical record review to obtain clinical quality data per the HEDIS/PNPP specifications set forth by the National Committee for Quality Assurance (NCQA). Collaborates with the Health Plan members and primary care providers in multiple practice sites to facilitate clinical guideline adherence and coordinates services as needed. Contributes to the design and implementation of interventions developed by quality improvement workgroups to achieve the goals and objectives de


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