Quality Specialist Ambulatory – Managed Care

Silver Cross Hospital; New Lenox (IL); Sur place; USD 70 000 - 110 000; Plein temps

Résumé du poste

Silver Cross Hospital in New Lenox, IL seeks a Quality Specialist Ambulatory – Managed Care to lead initiatives improving clinical outcomes across private practice settings and affiliated sites. You'll align with senior leadership to close care gaps, support practices, and drive a comprehensive quality strategy with emphasis on HEDIS and RAF outcomes.

The role partners with the CMO and Value Based Care teams to implement policies, coordinate care, and educate staff on practice transformation,

Qualifications

• Bachelor's degree in Business, Healthcare Administration, or related field required.
• 3-5 years clinical practice experience or experience improving clinical quality outcomes required.
• Excellent verbal, written, presentation, computer, and interpersonal communication skills.
• Highly Desired: ICD-10-CM/PCS Coding training and certification
• 3-5 years clinical practical experience
• 2-3 years CM, discharge planning and/or home health care coordination experience
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently (remote working).
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications.
• Efficient and Effective computer skills including navigating multiple systems and keyboarding

Responsabilités

• Subject matter expert regarding the HEDIS product line
• Represent the Clinical Integration product for client and internal business process meetings
• Collaboration with all affiliate service lines to impact HEDIS and Star ratings and to provide seamless client service
• Works with the Chief Medical Officer to ensure clinical, quality, and medical management processes align with outcomes
• Promotes linkage between utilization management, care coordination and quality improvement activities with partnered MSO
• Acts as a role model for clinical staff, promoting education and practice transformation
• Promotes collaboration with Director Value Based Care and Innovista, maintaining communication with CMO and Senior Leadership
• Development and implementation of Policies and Procedures for Clinical Operations in the clinical office setting
• Oversight of clinical training activities and outcomes

Connaissances

Excellent communication

Analytical skills

MS Office proficiency

Independent working

Interpersonal skills

Remote work capability

Formation

Bachelor's degree in Business, Healthcare Administration, or related field

ICD-10-CM/PCS Coding training and certification

Outils

MS Word

Excel

PowerPoint

Outlook

Description du poste

Position: Quality Specialist Ambulatory – Managed Care

Position Summary

Position will be responsible for creating, implementing, and maintaining a vision and plan for providing improved quality clinical outcomes to patients in the private practice setting, in collaboration with the Senior Leadership team. We will work with all practices of SCHC on closing care gaps, helpings practices, hospital, and ancillary sites in coordinating patients’ care plan, and work side by side with clinical leadership in creating Quality strategy moving forward.

Essential Duties and Responsibilities

• Subject matter expert regarding the HEDIS product line


• Represent the Clinical Integration product for both client and internal business process meetings


• Collaboration with all affiliate service lines to impact HEDIS and Star ratings and to provide seamless client service


• The position works closely with the Chief Medical Officer to ensure effective clinical, quality, and medical management operational processes and policies that align with targeted quality outcomes and goals for enrollees


• Promotes linkage between utilization management, care coordination and quality improvement activities with partnered MSO


• Acts as a role model for clinical staff, promoting education, development and adoption of practice transformation with focus on clinical workflow, member satisfaction, improved RAF scoring


• Promotes collaboration while working closely with Director Value Based Care and Innovista, in conjunction with maintaining appropriate communication with CMO and Senior Leadership


• Development, and implementation of Policies and Procedures for Clinical Operations in the clinical office setting


• Responsible for oversight of clinical training activities and outcomes.

Required Qualifications

Education and Training

• Bachelor's degree in Business, Healthcare Administration, or related field required.


• 3-5 years clinical practice experience or experience improving clinical quality outcomes required.


• Excellent verbal, written, presentation, computer, and interpersonal communication skills.


• Highly Desired: ICD-10-CM/PCS Coding training and certification


• 3-5 years clinical practical experience


• 2-3 years CM, discharge planning and/or home health care coordination experience


• Excellent analytical and problem-solving skills


• Effective communications, organizational, and interpersonal skills


• Ability to work independently (remote working).


• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications.


• Efficient and Effective computer skills including navigating multiple systems and keyboarding