RN Clinical Quality Research Analyst (HEDIS)

at Health Care Service Corporation in Chicago, Illinois, United States

Job Description

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!
Job Summary
This position is responsible for conducting data collection and abstraction of medical records for HEDIS and quality projects including supplemental data collection. Responsible for interacting with various internal staff, internal departments, and network providers to ensure quality performance and results for blue cross managed care products. Responsible for auditing all aspects of bcbsil clinical quality improvement projects and evaluating PCP/Mg/Ipa compliance with bcbsil clinical practice guidelines. Responsible for data analysis, interaction with providers* practices and Ipas to educate on HEDIS measures, gaps in care and quality programs. translate data into actionable information and determine areas for improvements as well as help implement actions toward improvement and report results to internal and external customers.

Hybrid position = requires 3-days Chicago IL office & 2-days WFH.

Required Job Qualifications:

Registered Nurse (RN) OR licensed clinician with current, unrestricted license in Illinois

Minimum of 3 years of clinical practice experience performing HEDIS medical record review (Required)

Minimum of 3 years of Healthcare or Managed Care experience, including quality improvement and/or project management experience (Required)

Minimum of 1 year HEDIS medical record data abstraction

Data analysis experience, skills and knowledge of statistical analysis software, and statistical methods and meaning knowledge

Ability to adapt to changing priorities and managing a wide range of quality projects

Able and willing to travel

Verbal and written communication skills

Problem resolution skills and ability to work with difficult situations with respect and diplomacy

Presentation planning and delivery experience for provider training

Preferred Job Qualifications:

Working knowledge of managed care programs and NCQA and/or URAC Accreditation guidelines

Project management experience and skills

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

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.

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Job Posting: 11948654

Posted On: Jun 03, 2024

Updated On: Jul 03, 2024

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