Quality Management Specialist II
This position can be based in Chicago, ABQ, NM, Southern New Mexico, OR Richardson.
This position is responsible for facilitating BCBS/HCSC clinical quality improvement projects and evaluation of provider compliance with BCBS/HCSC clinical practice guidelines; consults with 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 a preceptor for less experienced staff and contractors.
Registered Nurse (RN), Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN), 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 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.
PREFERRED JOB REQUIREMENTS:
Quality Improvement and/or Project Management experience.
Acute care / hospital clinical experience.
HEDIS, NCQA and/or Audit experience.
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 Quality Assurance Job Type Full-Time Regular Location IL - Chicago, TX - Richardson, NM - Albuquerque
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