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

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.