Claims Advisor for a leading vehicle insurance company, managing claims and ensuring customer satisfaction with efficient processes. Critical role in accuracy and regulatory compliance in compensation cases.
MI
Hybrid Quality Improvement Specialist
Posted 2 months ago
About the role
- Quality Initiatives Specialist at MercyCare Insurance responsible for leading quality improvement initiatives for health plan members. Analyzing clinical quality measures to ensure compliance and enhance patient care.
Responsibilities
- 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.
- Provide follow up and education of providers and clinic staff on measures and project objectives.
Requirements
- 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.
Benefits
- Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.
- Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.
- Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.
- Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.
- Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.
- Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.
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