HCSC
Quality Management Specialist II
This job is now closed
Job Description
- Req#: R0028919
Registered Nurse (RN), Physician's Assistant OR MSW (Master of Social Work)/LCSW (Licensed Clinical Social Worker) or other BH licensure with current, unrestricted license to practice in the state of operations OR Respiratory Therapist with master’s level or above degree
Medical specialty certification (Certified Professional in Healthcare Quality (CPHQ) or Diabetic Education) OR Bachelor Degree in medical field such as Nursing, Health Care Administration.
3 years clinical practice experience.
2 years' experience in health insurance or managed care.
2 years quality improvement and/or project management experience.
Experience conducting presentations for member and/or provider training.
Current unrestricted driver’s license.
Ability to travel including overnight stays.
Verbal and written communications skills.
Data analysis experience.
PC proficiency to include Word, Excel, and PowerPoint.
Licenses Nurse with HEDIS experience HIGHLY PREFERRED
Health plan QI (qualify improvement) HIGHLY PREFERRED
HEDIS audit experience.
Familiarity with EMR (electronic medical record) and Inovalon (HEDIS software)
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary
Summary:
This position is responsible for facilitating clinical quality improvement projects and evaluation of Provider/Provider Group compliance with clinical practice guidelines. This role will consult with Medical Groups, physicians, providers, and other resources to assess, plan, facilitate implement, coordinate, monitor and evaluate options and services required to meet clinical quality improvement project objectives.Required Job Qualifications:
Preferred Job Qualifications:
This is a Telecommute position.
Sponsorship will not be provided for this role.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range
$58,800.00 - $130,100.00About the company
Health Care Service Corporation (HCSC) is the largest member-owned health insurance company in the United States. HCSC offers a wide variety of insurance products and related services through Blue Cross and Blue Shield® of Illinois, Blue Cross and Bl...
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