Quality Management Specialist II

About the role

This position is responsible for facilitating BCBSIL clinical quality improvement projects and evaluating PCP/MG/IPA and HEDIS/QRS compliance with BCBSIL clinical practice guidelines. The role involves consulting with MG/IPAs, physicians, providers, members, and other resources to assess, plan, facilitate, implement, coordinate, monitor, and evaluate necessary options and services to meet clinical quality improvement project objectives. Additionally, this role serves as a preceptor for less experienced staff.

Responsibilities

• Facilitate BCBSIL clinical quality improvement projects
• Evaluate PCP/MG/IPA and HEDIS/QRS compliance with BCBSIL clinical practice guidelines
• Consult with MG/IPAs, physicians, providers, members, and other resources to assess, plan, facilitate, implement, coordinate, monitor, and evaluate necessary options and services to meet clinical quality improvement project objectives
• Serve as a preceptor for less experienced staff

Requirements

• 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
• 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

Preferred Requirements

• Experience with HEDIS/QRS medical record review validation
• Experience with NCQA HEDIS requirements, such as Inovalon software or other HEDIS approved software used in the industry

Pay

$61,500.00 - $136,100.00

Schedule

Nightly shifts may be required.

Benefits

Details not specified at this time.

Skills

Not specified at this time.

Benefits

Details not specified at this time.

Application Instructions

Details not specified at this time.