Market Quality Improvement Specialist I

Job Summary:

The Market Quality Improvement Specialist I manages monthly, quarterly, and annual reporting requirements for both Quality and Delegation Oversight teams.

Essential Functions:

• Assist Leadership with development and maintenance of Metric Dashboards for Quality and Delegation Oversight Teams
• Identify departmental development opportunities and work collaboratively with peers to develop the needed education
• Assist Leadership with reporting of case reviews that can be communicated at overall aggregate and individual levels
• Develop and maintain tracking of Quality Audits being conducted by Clinical Management and Enterprise Quality Improvement (QI) to report trending and compliance
• Complete queries and analyze reports to assist with completion of Monthly Delegation Oversight Scorecard metrics
• Aggregate Quality Raw Data Scores Monthly
• Complete monthly process for randomized reporting of member cases to be audited
• Develop and maintain monthly exception reporting to determine areas of opportunity for Quality & Delegation Oversight Teams to focus on
• Schedule and plan quarterly Joint Operating Committee meetings
• Plan monthly Delegation Oversight Committee presentation(s)
• Assist with maintenance and User Acceptance Testing (UAT) for SharePoint and Onbase databases and workflows
• Assist with developing reporting for monthly QI/QM meeting
• Assist with onboarding of new delegates
• Perform any other job related instructions as requested

Education and Experience:

• Associates degree in business, health administration, health policy or related discipline or equivalent years of relevant work experience is required
• A minimum of three (3) years of Managed Care or Healthcare Administration experience is required
• Experience in Quality Improvement, Case Management or Utilization Review  is preferred

Competencies, Knowledge and Skills:

• Intermediate in Microsoft Excel, Access and Word
• Intermediate skill level with SharePoint
• PowerPoint and Visio preferred
• Strong written and verbal communication skills  Ability to work independently and within a team environment
• Familiarity of the healthcare field
• Knowledge of Medicaid and Medicare
• Effective listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Effective problem solving skills with attention to detail
• Ability to develop, prioritize and accomplish goals
• Technical writing skills
• Ability to coordinate complex projects and multiple meetings
• Ability to work with a variety of disciplines and levels of staff across departments

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business