Quality Management Specialist II
Location: Downers Grove
Posted on: June 8, 2021
Job ID: DLP-1041819
IN OFFICE position located in Chicago HQ or Downers Grove,
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.
- 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 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
- Medical specialty certification (Certified Professional in
Healthcare Quality (CPHQ) or Diabetic Education)
- Masters Degree in medical field such as Nursing, Health Care
- 2 years of Health Plan Quality Experience
#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.
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
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