(Remote Work) Healthcare Quality Specialist – UpStream

Job Overview

• Job Title Healthcare Quality Specialist
• Hiring Organization UpStream
• Company Website https://www.upstream.ph/
• Remote Locations United States
• Job Type Remote, Full-Time

At UpStream we believe good health is a state of independence where each person has the capacity to live a long, happy, and active life. We aim to deliver the type of care our members need to regain and maintain their independence by delivering effective, efficient, and sustainable care.  We are a growing company and are excited to invite caring, detailed, and team-oriented people to join our team.

How you’ll help

Do you live and breathe HEDIS Quality?  Do you have in-depth knowledge of quality metrics?  Do you enjoy reading HEDIS specs?  As the UpStream Quality Specialist, you’ll have the opportunity to apply your Quality passion and your HEDIS knowledge to educating team members and partners, helping to maintain and improve UpStream quality performance, and helping or patients live longer, happier, and independent lives.  The UpStream Quality Specialist supports the centralized Quality team at UpStream and the assigned market.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Job Responsibilities

• Responsibility for primary source verification of data pulled from the EMR and displayed in Innovaccer of other UpStream applications.  The results of the audit may result in the need for changes in Innovaccer mapping or staff education on where to document results in the EMR.
• You will be the initial contact for all HEDIS and gap closure quality questions from the markets as well as UpStream internal staff such as the Health Concierge team.
• Respond to requests for data, slides or other reporting requests that can be pulled directly from Innovaccer or other data sources.  This individual does not replace the functions that require assistance for the UpStream analytics team.  Examples include information for provider meetings, internal presentations, etc.
• Act as primary resource for the health concierge team and help with quality training as requested.
• Support quality projects such as coordination of a mammogram bus or eye exam campaign.  Campaigns could be centralized or market specific.
• Assist with gap closure efforts as needed that may include chart pulls of needed documentation, data entry into appropriate portals, outbound calls to patients or other tasks as needed.
• Responsibility for administration of the LabCorp portal for home test kit mailing.
• Other duties as assigned

Job Requirements

• High School Education
• LPN license preferred
• HEDIS Quality gap closure knowledge and experience
• ACO or health plan experience preferred.

This is a remote position and hired candidate must reside in the Eastern time zone.

How To Apply

Click “Apply” below to fill in the application form!