Quality Improvement Coordinator

Quality Assurance Park Ridge, Illinois


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security.  Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina.  In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Job Summary:

Assist in quality improvement functions delineated in CCAI, Quality Management Program description.

Main Accountabilities:

  • Assists with HEDIS/medical evaluation studies including data collection, analysis, evaluation and reporting.
  • Participating in developing and implementing quality improvement interventions, including face-to-face and telephonic meetings with providers.
  • Assists in educating plan’s employees and providers about QI, HEDIS and STARS requirements. 
  • Assists with monitoring medical group corrective action plans.
  • Sends requests for medical records as needed.
  • Assists with tracking member outreach activities.
  • Assists with submission of non-compliant member reports to groups as required.
  • Attends QI/UM & PR Committee meetings.
  • Supports staff with problem solving of medical care related issues with providers.
  • Other tasks as assigned.

Qualifications:

  • Licensed Registered Nurse.
  • 2—5 years managed care experience in quality improvement.
  • Knowledge of Medicare Advantage quality requirements and Five-STAR Quality Rating System.
  • Knowledge of NCQA standards preferred.
  • Knowledge of billing codes including CPT, ICD-10 and HCPCS codes.
  • Strong analytical and problem-solving skills.
  • Strong computer skills – Microsoft Office Suite.
  • Strong communication and interpersonal skills.
  • 40% interstate travel required for this role in Illinois.