Quality Management Specialist II

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.

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Job Summary

Summary :

This position is responsible for facilitating clinical quality improvement projects and evaluation of Provider / Provider Group compliance with clinical practice guidelines.

This role will consult with Medical Groups, physicians, providers, and other resources to assess, plan, facilitate implement, coordinate, monitor and evaluate options and services required to meet clinical quality improvement project objectives.

Required Job Qualifications :

Registered Nurse (RN), 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 OR Respiratory Therapist with master’s level or above degree

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 unrestricteddriver’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 Qualifications :

Licenses Nurse with HEDIS experience HIGHLY PREFERRED

Health plan QI (qualify improvement) HIGHLY PREFERRED

HEDIS audit experience.

Familiarity with EMR (electronic medical record) and Inovalon (HEDIS software)

This is a Telecommute position.

Sponsorship will not be provided for this role.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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.

Base Pay Range

$58,800.00 - $130,100.00