Quality Management Specialist II

Job Summary

Position responsible for facilitating BCBSIL clinical quality improvement projects and evaluating PCP/MG/IPA and HEDIS/QRS compliance with BCBSIL clinical practice guidelines; consults with MG/IPAs, physicians, providers, members, and other resources to assess, plan, facilitate, implement, coordinate, monitor and evaluate options and services required to meet clinical quality improvement project objectives; serves as preceptor for less experienced staff.

• Registered Nurse (RN), Physician's Assistant, MSW (Master of Social Work)/LCSW (Licensed Clinical Social Worker) or other BH licensure with current, unrestricted license to practice in the state of operations
• Medical specialty certification (Certified Professional in Healthcare Quality (CPHQ) or Diabetic Education) OR Bachelor Degree in medical field such as Nursing, Health Care Administration.
• 3 years clinical practice experience.
• 2 years experience in health insurance or managed care.
• 2 years quality improvement and/or project management experience.
• Experience conducting presentations for member and/or provider training.
• Current unrestricted driver’s license.
• Ability to travel including overnight stays.
• Verbal and written communications skills.
• Data analysis experience.
• PC proficiency to include Word, Excel, and PowerPoint.

• Experience with HEDIS/QRS medical record review validation and/or experience with NCQA HEDIS requirements, such as Inovalon software or other HEDIS approved software used in the industry.

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

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 conditions of the plan.

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.

$61,500.00 - $

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