Quality Initiatives Specialist

Mercyhealth Wisconsin and Illinois

Janesville (WI)

On-site

USD 38,000 - 61,000

Full time

14 days+

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Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

FSA/HSA Options

Paid time off

Tuition and certification support

Job summary

Mercyhealth is seeking an MCIC Quality Initiatives Specialist to analyze clinical quality data, forecast performance, and support NCQA/HEDIS standards. You will plan quality improvement projects, coordinate outreach, and facilitate referrals to disease and case management programs.The role involves leading initiatives, data auditing, and collaboration with HEDIS teams and providers.

The position requires a Bachelor’s degree or 5+ years of related experience, plus EPIC experience and CQI

Qualifications

Bachelor’s degree 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 CQI methodologies: data collection, management, analysis and reporting.

Responsibilities

Lead specialist providing direction for projects and initiatives within the department.
Monitor outcomes to ensure goals and regulatory requirements are met.
Program and support databases to manage disease populations and improve workflows.
Design strategies for outcomes improvement based on population characteristics.

Skills

Project management

Communication

Data analysis

Persistence

Learning agility

Education

Bachelor’s degree

5+ years related healthcare experience

CPHQ/RHIT certification preferred

Tools

EPIC Tapestry

EPIC Healthy Planets

Microsoft Access

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. This includes: 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

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.

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

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: