Quality Improvement RN

• Completing large volume of medical record reviews – electronic chart reviews

• Reviewing and interpreting performance measures and documentation standards

• Utilizing computer applications for managing and tracking medical chart reviews

The Quality Improvement (QI) department objectively and systematically monitors and evaluates the quality, appropriateness, accessibility, and availability of safe and equitable medical and behavioral health care and services. To comply with regulatory and accreditation requirements, the QI department conducts annual medical record audits in physician offices members to ensure compliance with clinical care guidelines and documentation standards. Healthcare Effectiveness Data and Information Set (HEDIS) review is performed annually by the health plan and is managed by the QI department. HEDIS consists of a set of performance measures focused on preventive care and access to care.