Quality Management Specialist II

Health Care Service Corporation • Austin, TX

3d • $61,500 - $136,100 • Hybrid

About The Position

This position is responsible for facilitating BCBSIL clinical quality improvement projects and evaluation of PCP/MG/IPA and HEDIS/QRS compliance with BCBSIL clinical practice guidelines. The specialist 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. This role also serves 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 a 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.

Nice To Haves

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

Responsibilities

• Facilitating BCBSIL clinical quality improvement projects.
• Evaluating PCP/MG/IPA and HEDIS/QRS compliance with BCBSIL clinical practice guidelines.
• Consulting 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.
• Serving as preceptor for less experienced staff.
• Conducting presentations for member and/or provider training.

Benefits

• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement
• Annual incentive bonus plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level