Senior Manager Quality Improvement
BASIC FUNCTION :
This position is responsible for providing leadership in implementing quality improvement program for HCSC government programs, including successfully achieving at least 4 Star Medicare results on HEDIS and achieving performance goals for our Medicare/Medicaid plan (MMP). Related activities include the following: implement quality committees; develop and implement the quality initiatives; perform analysis, develop, implement and monitor HEDIS initiatives and performance for each Medicare contract and the MMP; work closely with the Physicians and Medical Groups to meet quality objectives and improve Star ratings/MMP performance; provide ongoing monitoring of HEDIS performance and remediate data issues; implement and monitor member and provider activities to improve the Star/MMP performance on HEDIS and HOS, and provide ongoing oversight of vendors implementing initiatives for each Medicare Contract.
REQUIRED JOB QUALIFICATIONS:
• Bachelor Degree in Health Services, Registered Nurse (RN) or Registered Physician Assistant (RPA) with current, unrestricted license.
• 2 years of managed care or health plan experience.
• 2 years of medical surgical and/or Quality Improvement and Utilization Review experience.
• 2 years leadership, supervisory or management experience.
• Knowledge of medical terminology and procedures.
• Experience in using Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts.
• Verbal and written communications skills in preparing recommendations and written documentation and facilitating work groups.
• Project management experience and skills.
• Knowledge of accreditation agency requirements ( i.e., NCQA, URAC).
• Knowledge of Federal and State regulatory requirements related to the Affordable Care Act.
• PC experience utilizing Microsoft Windows based products and database experience.
• Ability and willingness to travel, including overnight stays. PREFERRED JOB QUALIFICATIONS:
• 2 years supervisory or management experience.
PREFERRED JOB REQUIREMENTS:
• Experence workng with HEIDES
• Experience with Medicare Advantage Star Rating
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 Project Management, Nursing, Other Job Type Full-Time Regular Location IL - Chicago
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