Utilization Review Nurse
📋 Role Overview & Responsibilities
Job Title: Quality Improvement Specialist
Overview: Seeking a Quality Improvement Specialist to lead data collection, abstraction, and analysis for HEDIS and Quality projects. Responsibilities include auditing clinical quality improvement projects, analyzing data, and collaborating with providers to enhance quality measures.
Key Responsibilities:Interact with internal departments, network practitioners, and MG/IPAs to ensure quality for Blue Cross managed care products.Conduct audits for HMO Clinical Quality Improvement Projects, analyze data, and create reports for management.Develop reports for Quality Improvement Committees, perform quantitative and qualitative analysis, and conduct presentations.Perform onsite and concurrent audits for HEDIS Effectiveness of Care indicators and assist in re-training employees as needed.Communicate effectively and comply with corporate policies, including HIPAA and compliance program guidelines.
Requirements:RN or licensed clinician with current, unrestricted license in Illinois.Minimum 3 years of clinical practice experience, including HEDIS medical record reviews.Minimum 3 years of Healthcare or Managed Care experience, with proficiency in data analysis.Ability to adapt to changing priorities, travel as needed, and strong communication skills.Problem resolution skills and experience in presentation planning for provider training.
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This position is located in Chicago, IL with potential relocation and sponsorship assistance depending on candidate qualifications.
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