Quality Mgmt Spec II - FEP

Job ID: FIW-1016306 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.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.

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".

  • Knowledge of NCQA and/or URAC standards and guidelines is preferred *
  • POSITION CAN BE FILLED IN ANY OF THE HQs OF THE 5 BCBS PLANS (TX, OK, NM, MT, IL)*

BASIC FUNCTION:

This position is responsible for facilitating FEP clinical quality improvement projects and evaluation of provider compliance with HCSC 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.
  • 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 of clinical practice experience.
  • 2 years of experience in health insurance or managed care.
  • 2 years of quality improvement and/or project management experience.
  • Experience conducting presentations for member and/or provider training.
  • Current state of residence 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.

CB

LI-POST

DICE 14

CA

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


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