Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Summary: This position is responsible for facilitating clinical quality improvement projects and evaluation of PCP/MG/IPA compliance with clinical practice guidelines; consults with PCP/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. Will be responsible for ensuring documentation and QI activities demonstrate compliance with NCQA accreditation standards. Will also be responsible for the advancement of HEDIS quality metrics, and for optimizing member experience survey results. Note: Travel is not currently required in this position.JOB REQUIREMENTS:
Registered Nurse (RN) or Physician's Assistant OR MSW (Master of Social Work)/LCSW (Licensed Clinical Social Worker) or other BH licensure with current, unrestricted license to practice in the state of operations
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 unrestricted 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 REQUIREMENT
Experience with NCQA Healthplan Accreditation HIGHLY PREFERRED
Experience with HEDIS® HIGHLY PREFERRED
Familiar with Teams, Viva Engage, Sharepoint, Microsoft Suite, etc.
TELECOMMUTE
Sponsorship will not be provided for this role.
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
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