Quality Management Specialist II

Company: HCSC
Location: Downers Grove
Posted on: June 8, 2021

Job Description:

Job ID: DLP-1041819

Description:

IN OFFICE position located in Chicago HQ or Downers Grove, IL

BASIC FUNCTION:

This position is responsible for facilitating BCBSIL clinical quality improvement projects and evaluation of contract and NCQA compliance utilizing QI methods (RCA, PDSA, rapid cycle evaluation, data analysis) with BCBSIL clinical practice guidelines; consulting with physicians, providers, members, internal and external business partners; and other resources; is experienced in technical writing to assess, plan, facilitate, implement, coordinate, monitor and evaluate programs and services required to meet clinical quality improvement objectives; serving as preceptor for less experienced staff, and coordinating focused QI projects. Able to assess and utilize quantitative and qualitative data to plan projects and initiatives. Experience in working with Medicaid Health Plan Quality, Accreditation bodies such as URAC, NCQA; HEDIS, HEDIS Hybrid and or Medical Record Review. Candidate has committee planning and organizing such minute minutes and agenda setting.

JOB REQUIREMENTS:

• Registered Nurse (RN), LPN, LVN, 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 Masters level or above degree.
• 3 years clinical practice experience.
• 3 years experience in health insurance or managed care.
• 5 years quality improvement and/or project management experience.
• Experience developing, planning and conducting presentations for member and/or provider training.
• Current Illinois driver's license.
• Ability to travel including overnight stays.
• Verbal and written communications skills.
• Data analysis experience.
• PC proficiency to include Word, Excel, PowerPoint and Access or database system.

PREFERRED REQUIREMENTS:

• Medical specialty certification (Certified Professional in Healthcare Quality (CPHQ) or Diabetic Education)
• Masters Degree in medical field such as Nursing, Health Care Administration
• 2 years of Health Plan Quality Experience
• CA

#LI - DP1

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements:

Expertise Government Programs, Nursing Job Type Full-Time Regular Location IL - Downers Grove, IL - Chicago

Keywords: HCSC, Downers Grove , Quality Management Specialist II, Other , Downers Grove, Illinois