Manager Quality Improvement - Work From Home

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

Required Job Qualifications

• Registered Nurse (RN) or Registered Physician Assistant (RPA) with current, unrestricted license in the state of operations.
• 2 years’ experience using accreditation agency programs.
• 3 years of medical surgical and/or Quality Improvement and Utilization Review experience.
• 2 years of leadership or supervisory experience.
• Knowledge of medical terminology and procedures.
• Experience in using Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts.
• Analytical skills to analyze data and prepare reports.
• Verbal and written communications skills in preparing recommendations and written documentation in appropriate format and facilitating work groups.
• 5 years' hands-on Medicare Stars and HEDIS experience with direct accountability for improving quality measures, closing care gaps, increasing Star ratings, and delivering measurable improvements in provider performance and member outcomes.
• Project management experience and skills
• PC experience utilizing Microsoft Windows based products and database experience.

Preferred Job Requirements

• Possesses advanced technical knowledge of HEDIS methodology, measure specifications, numerator/denominator logic, exclusion criteria, care gap identification, and provider performance improvement, supported by direct HEDIS quality experience.
• 8 years' hands-on Medicare Stars and HEDIS experience with direct accountability for improving quality measures, closing care gaps, increasing Star ratings, and delivering measurable improvements in provider performance and member outcomes.

• 3 years' leading quality consultants, practice consultants, provider engagement teams, or population health staff with documented success improving HEDIS, Stars, quality, utilization, or performance metrics across multiple provider groups.
• 5 years' partnering directly with physician practices, medical groups, health systems, ACOs, or clinics to implement quality improvement initiatives, practice transformation efforts, and performance improvement strategies.
• Experience managing relationships with a multiple providers, physician groups, or practice leaders while influencing clinical and operational changes that resulted in measurable quality improvements.
• 5 years' supporting population health, preventive care, chronic disease management, care management, or value-based care programs within a health plan, provider organization, or healthcare system.
• Demonstrated success conducting provider and member outreach programs that closed annual care gaps and improved preventive screening rates, medication adherence, risk capture, or chronic condition management outcomes.
• 3 years' utilizing EMR/EHR data, HEDIS reports, care gap reports, provider scorecards, and quality dashboards to identify trends, monitor provider performance, develop action plans, and drive measurable quality improvement results.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

Exact compensation may vary based on skills, experience, and location.

About HCSC

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.

Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association

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