Clinical Quality Specialist, RN - Michigan

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Clinical Quality Specialist RN, to join in leading the organization forward.

MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

Position Summary:

The Clinical Quality Specialist RN is responsible for clinical elements of the PQI process for the Plan, participating in the HEDIS process, participating in NCQA activities, as well as implementing quality interventions and conducting evaluation to ensure on-going feedback and program effectiveness.

Essential Functions and Responsibilities:

Provides clinical knowledge (i.e. clinical standards of care, best practices) and support for Potential Quality Issues (PQI) for all lines of business for the Plan.
Investigates and responds timely to Potential Quality Issues (PQIs).
Participates in the annual HEDIS process.
Serves as subject matter expert on the certified HEDIS software system for support of the HEDIS process and other quality projects/reporting.
Works with manager in developing and promoting HEDIS initiatives, participating in applicable Quality Committees, and work groups as needed or required.
Serves a clinical reviewer of all quality documents.

Required:

Associate degree in nursing or related field.
Current valid RN License in state doing business in.
Five (5) years’ clinical or managed care health plan experience with at least two (2) years’ demonstrated experience in clinical quality improvement processes, including HEDIS and NCQA.

Preferred:

Bachelor’s degree in nursing or related field.
Project management experience.
CPHQ.
Healthcare data management and analysis experience.

Additional Information

Schedule: Full-time
Requisition ID: 26003085
Daily Work Times: 8:30 am - 5:00 pm
Hours Per Pay Period: 80
On Call: No
Weekends: No

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