Clinical Quality Research Analyst

Job ID: CAS-1018743 Description:

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.

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Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".

BASIC FUNCTION:

This position is responsible for HEDIS, QRS and Quality Improvement projects interacting with various internal staff and departments, and external network providers to ensure quality for Blue Cross managed care products. Responsible for Medical Record auditing of BCBSIL clinical quality improvement projects and evaluating PCP/MG/IPA compliance with BCBSIL clinical practice guidelines. Also responsible for data analysis, and interacting with providers to translate data into information, determines areas for improvements, helps implement actions toward improvement and reports results to internal and external customers.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with current, unrestricted license in state of operations.
  • Experience with HEDIS.
  • Minimum of 3 years' clinical practice experience.
  • Minimum of 3 years' Health Insurance or Managed Care experience, including quality improvement and/or project management experience.
  • Data analysis experience and knowledge of statistical analysis software, and statistical methods and meaning knowledge..
  • Able and willing to travel.
  • Verbal and written communication skills.
  • Data analysis experience and skills.
  • Project management experience and skills.
  • Experience with managing multiple tasks and working across the organization and providers.
  • Problem resolution skills and ability to work with difficult situations with tact and diplomacy.
  • Presentation planning and delivery experience for member and/or provider training.

PREFERRED REQUIREMENTS:

  • Working knowledge of managed care programs and NCQA.

Position is located in Chicago, IL.

LI-POST

  • CB*
  • CA

Requirements: Expertise Quality Assurance Job Type Full-Time Regular Location IL - Chicago


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