Quality Specialist Ambulatory – Managed Care

Silver Cross Hospital•New Lenox, IL

5d•Hybrid

About The Position

Silver Cross Hospital is seeking a Quality Specialist Ambulatory to join their team. This position will be responsible for creating, implementing, and maintaining a vision and plan for providing improved quality clinical outcomes to patients in the private practice setting, in collaboration with the Senior Leadership team. The role involves working with all practices of SCHC on closing care gaps, assisting practices, hospitals, and ancillary sites in coordinating patients’ care plans, and collaborating with clinical leadership in creating future quality strategies.

Requirements

Bachelor's degree in Business, Healthcare Administration, or related field required.
3-5 years clinical practice experience or experience improving clinical quality outcomes required.
Excellent verbal, written, presentation, computer, and interpersonal communication skills.
ICD-10-CM/PCS Coding training and certification
3-5 years clinical practical experience
2-3 years CM, discharge planning and/or home health care coordination experience
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently (remote working).
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications.
Efficient and Effective computer skills including navigating multiple systems and keyboarding

Responsibilities

Subject matter expert regarding the HEDIS product line
Represent the Clinical Integration product for both client and internal business process meetings
Collaboration with all affiliate service lines to impact HEDIS and Star ratings and to provide seamless client service
Works closely with the Chief Medical Officer to ensure effective clinical, quality, and medical management operational processes and policies that align with targeted quality outcomes and goals for enrollees
Promotes linkage between utilization management, care coordination and quality improvement activities with partnered MSO
Acts as a role model for clinical staff, promoting education, development and adoption of practice transformation with focus on clinical workflow, member satisfaction, improved RAF scoring
Promotes collaboration while working closely with Director Value Based Care and Innovista, in conjunction with maintaining appropriate communication with CMO and Senior Leadership
Development, and implementation of Policies and Procedures for Clinical Operations in the clinical office setting
Responsible for oversight of clinical training activities and outcomes.