Quality Initiatives Specialist

Mercy Health System Corporation; United States; On-site; USD 57,000 - 92,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Generous paid time off

Tuition and certification reimburse

Career advancement opportunities

Well-being programs

Employee discounts

Job summary

Mercyhealth is seeking a QC Initiatives Specialist to analyze clinical quality data, identify trends, and plan improvements. You will coordinate member/provider outreach and support disease management referrals to meet NCQA, HEDIS, and state/federal standards.

The role requires a Bachelor's degree plus 3+ years in managed care, with EPIC experience and CQI proficiency. Competitive benefits and a 40-hour week, day shift, on-site in a healthcare setting.

Qualifications

• Bachelor's degree from a four-year college or university in related field or at least 5 years of related experience.
• Three years of experience in managed care or health care delivery systems.
• Experience with EPIC applications (Tapestry and Healthy Planets).
• Experience with Continuous Quality Improvement methodologies: qualitative/quantitative data collection, management, analysis and reporting.

Responsibilities

• Lead project, program and initiative guidance for specialists within the department.
• Monitor and analyze outcomes to meet goals, accreditation, and regulatory requirements.
• Manage data using various software and portals for auditing and reporting.
• Develop and update policies, educate providers and clinic staff on measures and objectives.
• Support NCQA reviews, CAHPS and state audits as needed.

Skills

Priority management

Oral and written communication

Microsoft Office suite

Information systems literacy

Data warehousing basics

Education

Bachelor's degree in related field

CPHQ or RHIT certification preferred

Tools

EPIC (Tapestry, Healthy Planets)

Job description

OVERVIEW

The MCIC Quality Initiatives Specialist supports initiatives that improve behavioral and medical health outcomes for MercyCare Health Plan members and providers. In this role, you will analyze clinical quality data, identify trends, forecast performance, and present findings to support NCQA standards, HEDIS measures, and applicable state and federal requirements. You will use these insights to plan and carry out quality improvement projects, coordinate member and provider outreach, and facilitate referrals to disease and case management programs. SCHEDULE: 40-hours per week SHIFT: Days

ESSENTIAL DUTIES AND RESPONSIBILTIES

Acts as a lead specialist to provide project, program and /or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments. Assists in monitoring and analyzing outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met. Program and support Microsoft Access databases to manage targeted disease populations and provide efficiencies in work processes. Design and implement strategies for outcomes improvement based on membership population characteristics and business functions requirements. Participate in the implementation of Continuous Quality Improvement activities by contributing front line knowledge of projects and observations. Develop optimal alternative solutions based on feedback and environmental analysis. Implement process improvement using innovative thinking, root-cause-analysis, process mapping, and charting techniques. Complete Quality Initiative projects according to specifications and requirements.

• Following project policies and procedures.
• Accurate audit of measures.
• Data management: interfacing with and utilizing various software and portals for auditing and submitting data.
• Writing and updating policies and procedures.
• Provide follow up and education of providers and clinic staff on measures and project objectives.

HEDIS / Quality Reporting

Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review. Assists Manager in training and takes the lead role in these activities: Abstract data from the medical records and loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed. Works with the corporate HEDIS team to monitor accuracy of abstracted records as required by specifications. Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors. Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation. Provides data collection and report development support for quality improvement studies and performance improvement projects. Assists in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.

EDUCATION AND EXPERIENCE

Bachelor's degree from a four-year college or university in related field or at least 5 years of related experience. Three years of experience in managed care or health care delivery systems. Experience with EPIC applications (Tapestry and Healthy Planets) Experience with the following Continuous Quality Improvement methodologies required: Qualitative and quantitative data collection, management, analysis, and reporting.

CERTIFICATION AND LICENSURE

Certified Professional in Health Quality (CPHQ) or Registered Health Information Technician (RHIT) preferred.

SKILLS AND ABILITIES

• Management of priorities and deadlines.
• Good oral and written communication skills.
• Demonstrates persistence and overcomes obstacles.
• Proficiency with Microsoft Outlook, Word, Excel, and PowerPoint.
• Capable of learning to use information systems and external portals required for performing job functions.
• Basic understanding of data warehousing principles and familiar with tools used to extract data.

PAY RANGE

$27.71 - $44.34

EMPLOYMENT BENEFITS

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• Medical, Dental, Vision Life & Disability Insurance FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement Certification Reimbursement
• Well-being Programs Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities

EQUAL OPPORTUNITY

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

ABOUT MERCYHEALTH

At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50
• One of Working Mother magazine's 100 Best Companies for Working Mothers
• A Top 50 Company and Top 10 Nonprofit for Executive Women

For over 135 years, Mercyhealth has provided high-quality health care to residents throughout northern Illinois and southern Wisconsin. We have a passion for providing comprehensive health care close to home for area residents through our six hospitals and 85 primary and specialty care locations. As an integrated health system, you can come to us for routine health care, like annual physicals, immunizations and preventive health screenings, as well as highly specialized care, such as neonatal intensive care, heart surgery, stroke care, neurosurgery, cancer treatment and much more. The range of Mercyhealth's specialties and the skills of our doctors, nurses and clinical staff are truly extraordinary.

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