Quality Management Specialist II

Health Care Service Corporation • Full-time • Remote • $61.50k - $136.10k / year • 1d ago

Job Summary

This position is responsible for facilitating BCBSIL clinical quality improvement projects and evaluation of PCP/MG/IPA and HEDIS/QRS compliance with BCBSIL 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), 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 Requirements

Experience with HEDIS/QRS medical record review validation and/or experience with NCQA HEDIS requirements, such as Inovalon software or other HEDIS approved software used in the industry.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Base Pay Range
$61,500.00 - $136,100.00

Exact compensation may vary based on skills, experience, and location.