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Quality Specialist Ambulatory – Managed Care

Role overview

Qualifications

  • Minimum of an Associate’s degree in nursing
  • Two (2) years of experience in clinical documentation improvement or inpatient coding
  • Currently licensed as a Registered Nurse (RN)
  • Excellent verbal, written, presentation, computer, and interpersonal communication skills

Responsibilities

  • Create, implement, and maintain a vision and plan for improved quality clinical outcomes
  • Act as subject matter expert regarding the HEDIS product line
  • Collaborate with all affiliate service lines to impact HEDIS and Star ratings
  • Oversee clinical training activities and outcomes

Key facts

  • Remote from: United States
  • Full time
  • Mid-level (2-5 years)
  • English

Other skills

  • Analytical Skills
  • Communication
  • Organizational Skills
  • Problem Solving
  • Computer Keyboards
  • Collaboration
  • Teamwork

About the company

Silver Cross Hospital logo

Silver Cross Hospital

Hospitals & Health Care

Silver Cross Hospital is an independent, not-for-profit healthcare provider serving Will County and southwest suburban communities since 1895. We have been recognized as a 100 Top Hospitals National Award winner 11 times, honored with an “A” Hospital Safety Grade by The Leapfrog Group 19 times, and are rated 5 Stars by the Centers for Medicare and Medicaid Services. In 2024, Healthgrades ranked Silver Cross #1 in Illinois for surgical care. With over 4,500 employees, physicians and volunteers, Silver Cross operates a 348-bed acute care hospital and 12 satellite facilities providing outpatient services and physician offices. We also operate a freestanding Emergency Department in Homer Glen, open 24/7, and 2 Urgent Care Centers, one in New Lenox on our main campus, and one in Mokena. We also operate Will County's ONLY Level III Perinatal Center with a 24-bed Neonatal Intensive Care Unit (NICU) through our collaboration with Ann and Robert H. Lurie Children's Hospital of Chicago. What's more, Silver Cross partners with Chicago's leading academic medical centers to bring our community world-class care close to home, including University of Chicago Medicine, Shirley Ryan AbilityLab, Ann and Robert H. Lurie Children's Hospital of Chicago, and Rush University System for Health. Additionally, we partner with CTVSA (Cardiothoracic & Vascular Surgical Associates) for our nationally ranked heart program, as well as US HealthVest through the 100-bed Silver Oaks Behavioral Hospital, located directly across from our main hospital campus. To learn more about Silver Cross Hospital, visit silvercross.org.

Company details

IndustryHospitals & Health Care
Company size1001 - 5000

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Job description

Silver Cross Hospital is an extraordinary place to work. We’re known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It’s the way you want to be treated.

Position SummaryPosition 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:

  • A minimum of an Associate’s degree in nursing and two (2) years of experience in clinical documentation improvement or inpatient coding, OR
  • 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

Licenses/Certifications Required:

  • Currently licensed as a Registered Nurse (RN)

Work Shift Details:

Days, Days

Department:

CLINICAL DOCUMENTATION

Benefits for You

At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members.   

Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:

·       Medical, Dental and Vision plans

·       Life Insurance

·       Flexible Spending Account

·       Other voluntary benefit plans

·       PTO and Sick time

·       401(k) plan with a match

·       Wellness program

·       Tuition Reimbursement

Registry employees who meet eligibility may participate in our 401(k) Savings plan with a potential match.  However, registry employees are ineligible for Health and Welfare benefits.

The expected pay for this position is listed below:

$35.76 - $45.60

The final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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