Health Plan Quality Administrator, Michigan

McLaren Health Care; Flint (MI); On-site; USD 65,000 - 90,000; Full time

Job summary

McLaren Health Plan in Michigan is seeking a Quality Administrator to lead the quality program and ensure compliance with NCQA, HEDIS, and CAHPS requirements. The role focuses on coordinating performance improvement initiatives and reporting to quality committees.

You will work with MIG quality staff, develop interventions, monitor regulatory projects, and support site audits. Full-time position with standard daytime hours, based in Flint, MI.

Qualifications

• Bachelor’s degree in health care, business or related field required.
• Four years of regulated health organization or managed care experience with two years in quality activities (HEDIS/NCQA).
• Prefer Master’s degree and 6+ years in regulated health care with 3+ years in quality.

Responsibilities

• Provide updates to MIG quality staff and committees on recommendations and actions for the QIP.
• Propose targeted actions, aid in developing interventions and coordinate implementation of quality ops.
• Coordinate regulatory responsibilities including HEDIS, CAHPS, NCQA standards and state projects.
• Oversee site audits and other regulatory agency activities as assigned.

Skills

Quality management

HEDIS

NCQA

Regulatory compliance

Stakeholder communication

Education

Bachelor's degree in health care, business or related field

Master's degree (preferred)

Job description

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Quality Administrator, to join in leading the organization forward.

MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

Position Summary

Responsible for routinely providing updates to all MIG quality staff and the applicable Quality Committees concerning recommendations and suggested courses of action pertinent to the efficient operation of the Quality Improvement Performance Plan (QPIP). Responsible for proposing targeted actions, aiding in the development of the interventions and coordinating the implementation of all quality operations. Coordinates specific regulatory and contractual responsibilities of assigned HMO including, but not limited to, HEDIS, CAHPS, NCQA Standard compliance, state performance projects, site audits and any other regulatory agencies.

Qualifications

Required

• Bachelor’s degree in health care, business or a related field.
• Four (4) years’ experience with a government regulated health organization or a managed care setting with at least two (2) years’ experience performing complex quality management activities including HEDIS, NCQA etc.

Preferred

• Master’s degree in health care related field.
• 6 (six) years’ experience with a government regulated health organization or a managed care setting with at least three (3) years’ experience performing complex quality management activities including HEDIS, NCQA etc.
• Recent related work experience at an established HMO.

Additional Information

• Schedule: Full-time
• Requisition ID: 26002954
• Daily Work Times: 8:30 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No