Quality Improvement Specialist, MercyCare Insurance

Mercyhealth • Janesville, WI

7h • Hybrid

About The Position

The MCIC Quality Initiatives Specialist is responsible for planning and conducting activities concerned with the quality improvement of behavioral and medical health initiatives for MercyCare Health Plan members and providers. To this end, this position will analyze, review, forecast, trend, and present information relating to clinical quality measures presented by NCQA, HEDIS, and other state and federal regulations. The MCIC Quality Initiatives Specialist 3will use that information in various quality improvement projects resulting in member and provider outreach and referrals to disease and case management. Perform other duties as assigned.

Requirements

• Bachelor's degree from a four-year college or university in related field or at least 5 years of related experience.
• Three years of experience in managed care or health care delivery systems.
• Experience with EPIC applications (Tapestry and Healthy Planets)
• Experience with the following Continuous Quality Improvement methodologies required: Qualitative and quantitative data collection, management, analysis, and reporting.

Nice To Haves

• Certified Professional in Health Quality (CPHQ) or Registered Health Information Technician (RHIT) preferred.

Responsibilities

• Acts as a lead specialist to provide project, program and /or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.
• Assists in monitoring and analyzing outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Program and support Microsoft Access databases to manage targeted disease populations and provide efficiencies in work processes.
• Design and implement strategies for outcomes improvement based on membership population characteristics and business functions requirements.
• Participate in the implementation of Continuous Quality Improvement activities by contributing front line knowledge of projects and observations.
• Develop optimal alternative solutions based on feedback and environmental analysis.
• Implement process improvement using innovative thinking, root-cause-analysis, process mapping, and charting techniques.
• Complete Quality Initiative projects according to specifications and requirements. This includes: Following project policies and procedures. Accurate audit of measures. Data management: interfacing with and utilizing various software and portals for auditing and submitting data.
• Writing and updating policies and procedures.
• Provide follow up and education of providers and clinic staff on measures and project objectives.HEDIS / Quality Reporting
• Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review
• Assists Manager in training and takes the lead role in these activitiesAbstract data from the medical records and loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
• Works with the corporate HEDIS team to monitor accuracy of abstracted records as required by specifications.
• Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors.
• Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
• Provides data collection and report development support for quality improvement studies and performance improvement projects.
• Assists in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.

Benefits

• Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.
• Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.
• Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.
• Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.
• Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.
• Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees