Quality Initiatives Specialist

Mercy Health Corporation; Janesville (WI); On-site; USD 39,000 - 61,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

Paid time off

Job summary

Mercyhealth seeks a Quality Initiatives Specialist to analyze clinical quality data, forecast performance, and present findings supporting NCQA standards and HEDIS measures. You will plan quality improvement projects, coordinate member/provider outreach, and facilitate referrals to disease and case management programs.

The role involves leading initiatives, monitoring outcomes, and assisting in training and data submission across medical records and HEDIS applications.

Qualifications

• Bachelor's degree in a related field or 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).
• Continuous Quality Improvement methodologies: data collection, management, analysis, and reporting.

Responsibilities

• Lead specialist for department initiatives and guidance.
• Monitor and analyze outcomes to meet requirements.
• Manage targeted disease populations using Access databases.
• Design strategies for outcomes improvement.
• Support continuous quality improvement activities and project follow-ups.
• Perform data abstraction and verify documentation against specifications.
• Coordinate and prepare HEDIS medical record reviews.
• Support accreditation activities and data reporting.

Skills

Priority management

Communication skills

Persistence

MS Office

Data warehousing basics

Data extraction tools

Education

Bachelor's degree in related field

3+ years managed care experience

CPHQ / RHIT 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. 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:

• #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