Quality Management Specialist - Hedis, A Plus

Hcsc Oklahoma City , OK 73113

Posted 2 months ago

Job ID: AH-1031517 Description:

BASIC FUNCTION:

This position is responsible for facilitating BCBSIL clinical quality improvement projects and evaluation of PCP/MG/IPA compliance with BCBSIL clinical practice guidelines; 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; serves as preceptor for less experienced staff.

JOB REQUIREMENTS:

  • Registered Nurse (RN), Licensed Practical Nurse (LPN), Respiratory Therapist, or other medical specialty, i.e. Physicians Assistant, Corpsman with unrestricted license in state.

  • Medical specialty certification (Certified Professional in Healthcare Quality (CPHQ) or Diabetic Education) OR Bachelor Degree in 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 Illinois driver's license.

  • Verbal and written communications skills.

  • Data analysis experience.

  • PC proficiency to include Word, Excel, and PowerPoint.

PREFERRED:

HEDIS/Accreditation experience highly desired

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.

Requirements:
Expertise Nursing Job Type Full-Time Regular Location OK - Oklahoma City, MT - Helena, TX - Richardson, IL - Chicago, NM - Albuquerque


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Quality Management Specialist - Hedis, A Plus

Hcsc