Quality Improvement Specialist, MercyCare Insurance

Quality Improvement Specialist, Mercy Care Insurance

Join to apply for the Quality Improvement Specialist role at Mercyhealth Wisconsin and Illinois.

The MCIC Quality Initiatives Specialist is responsible for planning and conducting activities concerning the quality improvement of behavioral and medical health initiatives for Mercy Care Health Plan members and providers. The position analyses, reviews, forecasts, trends, and presents information related to clinical quality measures presented by NCQA, HEDIS, and other state and federal regulations. This information is used in various quality improvement projects for member and provider outreach and referrals to disease and case management.

• Lead specialist providing project, program, and initiative‑related direction and guidance to other specialists and other departments.
• Monitor and analyze outcomes to ensure goals, accreditation, and regulatory requirements are met.
• Program and support Microsoft Access databases for managing targeted disease populations and improving work processes.
• Design and implement strategies for outcomes improvement based on membership population characteristics and business functions requirements.
• Participate in Continuous Quality Improvement activities, contributing frontline 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, andatudting techniques.
• Complete Quality Initiative projects according to specifications and requirements, including following project policies and procedures, accurate audit of measures, and data management.
• Write and update policies and procedures.
• Provide follow‑up and education of providers and clinic staff on measures and project objectives.
• Lead coordination and preparation of HEDIS medical record review processes; abstract data from medical records and load into HEDIS application.
• Work with corporate HEDIS team to monitor accuracy of abstracted records and participate in scheduled meetings with vendors and auditors.
• Assist quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
• Provide data collection and report development support for quality improvement studies and performance improvement projects.
• Assist in support of accreditation activities such as NCQA reviews, CAHPS, and state audits.

• Bachelor's degree from a four‑year college or university in a related field or at least five 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 continuous quality improvement methodologies: qualitative and quantitative data collection, management, analysis, and reporting.

• Certified Professional in Health Quality (CPHQ) or Registered Health Information Technician (RHIT至少 preferred.

• Retirement plan with competitive matching contributions, comprehensive medical, dental, and vision insurance options.
• Competitive compensation and special pay incentive programs.
• Generous paid time off that increases with milestone anniversaries.
• Educational assistance programs and career ladder support.
• Well‑being resources, health risk assessment, and wellbeing mobile application.
• Employee assistance programs, discount packages, paid parental and caregiver leaves, on‑demand pay, and financial education.

Referrals increase your chances of interviewing at Mercyhealth Wisconsin and Illinois by 2x.

• Seniority level:
  Mid‑Senior level
• Employment type:
  
  Full‑time
• Job function:
  Quality Assurance
• Industries:
  Hospitals and Health Care

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