Manager Quality Improvement - Work From Home

Health Care Service Corp.; United States; Hybrid; USD 84,000 - 152,000; Full time

Benefits offered by this job

Health insurance & wellness benefits

401(k) plan

Paid time off & parental leave

Disability insurance

Job summary

Health Care Service Corporation (HCSC) is seeking a qualified professional to support population health, quality improvement, and value-based care initiatives. You will collaborate with provider groups, clinicians, and internal partners to identify and close care gaps, educate providers, and improve quality measures.

The role requires RN or PA licensure, extensive HEDIS/STARs experience, and leadership capabilities.

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.
• 5 years' hands-on Medicare Stars and HEDIS experience with direct accountability for improving quality measures, closing care gaps, increasing Star ratings, and delivering measurable improvements in provider performance and member outcomes.
• Project management experience and skills.
• PC experience utilizing Microsoft Windows based products and database experience.

Responsibilities

• Support population health, quality improvement, and value-based care initiatives.
• Collaborate with provider groups, clinicians, and internal business partners.
• Provide embedded provider support, member outreach, care gap identification and closure.
• Educate providers and contribute to quality measure improvement.
• Implement clinical and operational strategies to enhance preventive care.
• Drive outcomes in value-based care programs.

Skills

RN/PA licensure knowledge

Medicare Stars & HEDIS expertise

Population health analytics

Project management

Quality improvement

Data reporting

Verbal & written communication

Leadership or supervisory

PC proficiency & databases

Tools

EMR/EHR data

Quality dashboards

Provider scorecards

Care gap reports

Job 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.

Job Summary

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, and implementation of clinical and operational strategies that enhance preventive care, improve health outcomes, and support value-based care objectives.

Required Job 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.
• 5 years' hands-on Medicare Stars and HEDIS experience with direct accountability for improving quality measures, closing care gaps, increasing Star ratings, and delivering measurable improvements in provider performance and member outcomes.
• Project management experience and skills.
• PC experience utilizing Microsoft Windows based products and database experience.

Preferred Job Requirements

• Possesses advanced technical knowledge of HEDIS methodology, measure specifications, numerator/denominator logic, exclusion criteria, care gap identification, and provider performance improvement, supported by direct HEDIS quality experience.
• 8 years' hands-on Medicare Stars and HEDIS experience with direct accountability for improving quality measures, closing care gaps, increasing Star ratings, and delivering measurable improvements in provider performance and member outcomes.
• 3 years' leading quality consultants, practice consultants, provider engagement teams, or population health staff with documented success improving HEDIS, Stars, quality, utilization, or performance metrics across multiple provider groups.
• 5 years' partnering directly with physician practices, medical groups, health systems, ACOs, or clinics to implement quality improvement initiatives, practice transformation efforts, and performance improvement strategies.
• Experience managing relationships with a multiple providers, physician groups, or practice leaders while influencing clinical and operational changes that resulted in measurable quality improvements.
• 5 years' supporting population health, preventive care, chronic disease management, care management, or value-based care programs within a health plan, provider organization, or healthcare system.
• Demonstrated success conducting provider and member outreach programs that closed annual care gaps and improved preventive screening rates, medication adherence, risk capture, or chronic condition management outcomes.
• 3 years' utilizing EMR/EHR data, HEDIS reports, care gap reports, provider scorecards, and quality dashboards to identify trends, monitor provider performance, develop action plans, and drive measurable quality improvement results.

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 https://careers.hcsc.com/totalrewards. 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

$84,400.00 - $152,300.00 Exact compensation may vary based on skills, experience, and location.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

HCSC Employment Statement

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.

We are a drug-free and smoke-free workplace.

Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.