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Quality Management Specialist II - HEDIS

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Job Details
Job Order Number
7395239
Company Name
Health Care Service Corporation
Physical Address
300 SOUTH RANDOLPH
Chicago, IL 60601
Job Description

Description:

There are two positions associated with this posting.

BASIC FUNCTION:This position is responsible for facilitating clinical quality improvement projects and evaluation of PCP/MG/IPA compliance with clinical practice guidelines; consults with MG/IPAs, physicians, providers, members, and other resources to assess, plan, facilitate implement, coordinate, monitor and evaluate options and services required to meet clinical quality improvement project objectives; serves as preceptor for less experienced staff.

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 master’s level or above degree

  • 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 JOB REQUIREMENTS:

  • Quality improvement and/or project management experience.
  • Registered Nurse (RN) is preferred
  • 2+ HEDIS experience is preferred
  • Knowledge of NCQA standards is a plus
  • Strong computer proficiency in MS Office Suite

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.

BCBSTX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.


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