Process Improvement Specialist (Clinical)

About the Role

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

Responsibilities

• Review 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 analysis and responses on all quality measures, including performance development and reporting, and provide recommendations.
• Review member survey results from internal and external sources for operational implications and recommend process improvements.
• Collaborate with the analytics team on identified process improvement reporting and scheduling.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

• Must reside in the state of Michigan.
• Auditing experience highly preferred.
• Bachelor’s degree in Healthcare, a 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.