[Hiring] Quality Improvement Manager @Health Care Service Corporation

Role Description

This position is responsible for supporting population health, quality improvement, and value-based care initiatives through close collaboration with provider groups, clinicians, and internal business partners. Responsibilities include:

• Embedded provider support
• Member outreach
• Care gap identification and closure activities
• Provider education
• Quality measure improvement
• Implementation of clinical and operational strategies that enhance preventive care, improve health outcomes, and support value-based care objectives

Qualifications

• Registered Nurse (RN) or Registered Physician Assistant (RPA) with current, unrestricted license in the state of operations
• 2 years’ experience using accreditation agency programs
• 3 years of medical surgical and/or Quality Improvement and Utilization Review experience
• 2 years of leadership or supervisory experience
• Knowledge of medical terminology and procedures
• Experience in using Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts
• Analytical skills to analyze data and prepare reports
• Verbal and written communications skills in preparing recommendations and written documentation in appropriate format and facilitating work groups
• Project management experience and skills
• PC experience utilizing Microsoft Windows based products and database experience

Requirements

• Experience supporting population health, preventive care, or care management initiatives within a health plan, medical group, or healthcare system
• Experience conducting provider and member outreach to improve quality outcomes and close gaps in care
• Demonstrated success leading individuals in improving HEDIS, STAR, quality, or performance metrics through provider engagement and operational interventions
• Experience working within provider offices, clinics, or health systems to implement quality improvement initiatives
• Knowledge of value-based care, risk-based contracting, and population health management strategies
• Prior leadership of quality consultants, clinical quality specialists, practice consultants, or population health teams
• Experience leading large-scale quality or population health initiatives across multiple markets, provider groups, or regions
• Experience collaborating with multidisciplinary teams to improve member engagement, access to care, and health outcomes
• The ability to speak both the clinical language of providers and the operational language of health plan leadership
• Medicare Stars and HEDIS expertise that goes beyond reporting and includes driving measurable improvement
• Experience reviewing and utilizing EMR data, care gap reports, and quality dashboards to drive performance improvement
• Proven ability to build trusted relationships with physicians, practice administrators, and clinical staff
• A track record of improving quality metrics through provider engagement rather than solely through internal analytics
• Experience supporting practice transformation, workflow optimization, or clinical process improvement initiatives
• Knowledge of preventive health measures, chronic disease management, and quality performance programs

Benefits

• 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
• Other incentives

Company Description

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are 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.