Clinical Quality Managed Care Specialist
Who you are:
As a Clinical Quality Managed Care Specialist, you are a guru when it comes to working in a NCQA-accredited managed care organization.
You not only understand Clinical HEDIS and Stars Measures, you have led the implementation of interventions and continuous quality improvement and you understand the impact you have on quality outcomes.
You care about the details and are an excellent communicator.
What you'll do:
As a Clinical Quality Managed Care Specialist you will partner with the Care Management Department on the following:
You'll help the Care Management (CM) team meet regulatory requirements and compliance with accreditation standards You will develop and coordinate activities related to:
NCQA standards and reporting Clinical HEDIS measures Quality Improvement initiatives and outcomes Work with data teams to identify data needs, analyze, and synthesize data to report out on outcomes/ findings.
Provide delegation oversight for Care Management vendors What you'll bring:
Licensure as an RN (in MD or compact multi-state), LCSW (MD) or LMHC (MD).
7
years of healthcare experience, and 5
years in managed care environment 2
years' experience in an NCQA-accredited managed care organization with focus on quality improvement or health services.
Working knowledge of National Committee for Quality Assurance (NCQA) standards, HEDIS, delegation oversight, audits, monitoring, and evaluations processes.
Master's degree in a healthcare related field such as Nursing, Public Health, or Health Care Administration.
PMP or CPHQ certification preferred Who we are:
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine.
JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments.
JHHP is a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry.
We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.
If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Recommended Skills Auditing Certified Project Management Professional Clinical Works Continuous Quality Improvement (Cqi) Health Administration Licensed Clinical Social Worker (Lcsw) Apply to this job.
Think you're the perfect candidate? Apply on company site $('.
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open('/interstitial?jobdid=j3n05n6gsf0bwpcm8bz', 'ExternalApply-j3n05n6gsf0bwpcm8bz'); ); Estimated Salary: $20 to $28 per hour based on qualifications.
As a Clinical Quality Managed Care Specialist, you are a guru when it comes to working in a NCQA-accredited managed care organization.
You not only understand Clinical HEDIS and Stars Measures, you have led the implementation of interventions and continuous quality improvement and you understand the impact you have on quality outcomes.
You care about the details and are an excellent communicator.
What you'll do:
As a Clinical Quality Managed Care Specialist you will partner with the Care Management Department on the following:
You'll help the Care Management (CM) team meet regulatory requirements and compliance with accreditation standards You will develop and coordinate activities related to:
NCQA standards and reporting Clinical HEDIS measures Quality Improvement initiatives and outcomes Work with data teams to identify data needs, analyze, and synthesize data to report out on outcomes/ findings.
Provide delegation oversight for Care Management vendors What you'll bring:
Licensure as an RN (in MD or compact multi-state), LCSW (MD) or LMHC (MD).
7
years of healthcare experience, and 5
years in managed care environment 2
years' experience in an NCQA-accredited managed care organization with focus on quality improvement or health services.
Working knowledge of National Committee for Quality Assurance (NCQA) standards, HEDIS, delegation oversight, audits, monitoring, and evaluations processes.
Master's degree in a healthcare related field such as Nursing, Public Health, or Health Care Administration.
PMP or CPHQ certification preferred Who we are:
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine.
JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments.
JHHP is a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry.
We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.
If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Recommended Skills Auditing Certified Project Management Professional Clinical Works Continuous Quality Improvement (Cqi) Health Administration Licensed Clinical Social Worker (Lcsw) Apply to this job.
Think you're the perfect candidate? Apply on company site $('.
external-apply-email-saved').
on('click', function (event) window.
ExternalApply = window.
open('/interstitial?jobdid=j3n05n6gsf0bwpcm8bz', 'ExternalApply-j3n05n6gsf0bwpcm8bz'); ); Estimated Salary: $20 to $28 per hour based on qualifications.
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