Process Improvement Specialist (Clinical)

About the role

Plan, develop and track process improvement and operational projects related to clinical outcomes for products and ensure integration with delivery systems including service/care coordination. Serve as the primary subject matter expert for clinical health outcomes.

• Review of all clinical member materials, including service coordination brochures, handbook references, and educational leaflets.
• Serve as a liaison for all clinical initiatives including case and disease management, behavioral health, and HEDIS outcome measures.
• Evaluate the analysis and responses on all quality measures including performance development and reporting, and provide recommendations.
• Review member survey results from internal as well as external sources for implications to operations and make recommendations for process improvements accordingly.
• Collaborate with analytics team on identified process improvement reporting and scheduling.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

• Must reside in the state of Michigan.
• Auditing experience highly preferred.

Qualifications

• Bachelor’s degree in Healthcare, related field, or equivalent experience.
• 5+ years of process improvement experience, preferably in a managed care environment.
• Experience in project coordination preferred.
• Current state’s RN or LCSW license.
• Driver’s license preferred.

Pay

$70,100.00 - $126,200.00 per year. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field, or office work schedules.

Benefits may be subject to program eligibility.