Meridian of Illinois · 10 hours ago
Quality Improvement Specialist Senior
Willowbrook, IL
Full-time
Hybrid
Mid, Senior Level
$70K/yr - $126K/yr
3+ years expMeridian of Illinois is a diversified, national organization focused on transforming the health of communities. The Senior Quality Improvement Specialist is responsible for leading quality improvement initiatives related to CMS Star/HEDIS performance and ensuring compliance with regulatory and accreditation standards.
Hospital & Health Care
Responsibilities
Leads and manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services provided to members
Ensures that clinical and service quality improvement programs and initiatives are compliant with applicable accreditation, state and federal requirements
Conducts an assessment of programs, initiatives and interventions to ensure goals and objectives were met and refine activities, as needed, to improve the effectiveness and improve outcomes
Conducts vendor oversight and management
Develops targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other identified performance measures
Develops and implements project-related communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas
Participates in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities
Develops internal reports to demonstrate progress on each initiative/project and presents to senior-level staff
Describes outreach initiatives, potential/experienced barriers and activities to resolve issues and improve outcomes
Leads and/or participates in multi-department/cross-functional committees and work groups which support key initiatives, prepares reports, data, agendas/minutes or other materials for committee presentation and management
Identifies areas of improvement within the company and works collaboratively with other departments to develop clinical and non-clinical performance improvement projects
Researches best practices, national and regional benchmarks, and industry standards
Develops collaborative relationships with contracted providers or provider groups to promote participation in quality improvement collaboratives to improve clinical care outcomes
May lead and/or participate in external activities, work groups or committees when applicable
Communicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures
Develops and/or maintains relationships with other external organizations to expand key partnerships
Assesses current industry trends and regulations for enterprise-wide adoption to assure quality and effectiveness of health care delivery and/or healthcare services provided to members
Performs all other duties as assigned
Performs other duties as assigned
Complies with all policies and standards
Qualification
Required
Bachelor's Degree or equivalent experience with clinical license or Master's Degree in related health field (i.e. MPH or MPA)
Minimum three years experience in a clinical/health care environment with related degree program
Three to five years managed care experience in a health care environment
Experience in compliance, accreditation, service or quality improvement
Complex project management experience
Preferred
Valid State Clinical License
Certified Professional in Health Care Quality (CPHQ)
Experience With Medicare And/or NCQA
Preference will be given to applicants with (1) state clinical licensure, (2) Illinois residency (3) who have experience with project management and experience owning quality improvement deliverables within a health insurance setting
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
Meridian of Illinois
As a Medicaid MCO, Meridian of Illinois provides healthcare to beneficiaries enrolled in the Family Health Plan and Integrated Care Program through a contract with the Illinois Department of Healthcare and Family Services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Daniel Rich
Plan Chief Operating Officer
Company data provided by crunchbase