At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary
Summary:
This position is responsible for facilitating clinical quality improvement projects and evaluation of PCP/MG/IPA compliance with clinical practice guidelines; consults with PCP/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. Will be responsible for ensuring documentation and QI activities demonstrate compliance with NCQA accreditation standards. Will also be responsible for the advancement of HEDIS quality metrics, and for optimizing member experience survey results.
Note: Travel is not currently required in this position.
JOB REQUIREMENTS:
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Registered Nurse (RN) or 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
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Medical specialty certification (Certified Professional in Healthcare Quality (CPHQ) or Diabetic Education) OR Bachelor Degree in medical field such as Nursing, Health Care Administration.
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3 years clinical practice experience.
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2 years experience in health insurance or managed care.
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2 years quality improvement and/or project management experience.
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Experience conducting presentations for member and/or provider training.
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Current unrestricted driver’s license.
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Ability to travel including overnight stays.
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Verbal and written communications skills.
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Data analysis experience.
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PC proficiency to include Word, Excel, and PowerPoint.
PREFERRED JOB REQUIREMENT
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Experience with NCQA Healthplan Accreditation HIGHLY PREFERRED
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Experience with HEDIS® HIGHLY PREFERRED
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Familiar with Teams, Viva Engage, Sharepoint, Microsoft Suite, etc.
TELECOMMUTE
Sponsorship will not be provided for this role.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range$58,800.00 - $130,100.00
Top Skills
What We Do
Imagine Something New, Something Different.
Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families.
HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development.
HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC.
Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization.
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
