Quality Perform Specialist Clinical

**Work Arrangement:**

Remote based position with a strong preference for a North Carolina resident. Will support the North Carolina plan. **RN required**

**Responsibilities:**

As part of the Quality Management team, the Quality Performance Specialist -Clinical is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing standards of care. In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and Clinical Practice Guidelines. The position also supports accreditation and clinical quality performance improvement activities. Strong maternal and / or women's health background strongly preferred.

+ Assumes responsibility for performing quality of care reviews to include all sentinel events and member concerns. Coordinates reviews with physician advisors and clinical quality committees as appropriate.
+ Assures minimally neces...