Mercyhealth Wisconsin and Illinois ยท 1 day ago
Quality Improvement Specialist, MercyCare Insurance
Janesville, WI
Full-time
Hybrid
Mid, Senior Level
5+ years expMercyhealth Wisconsin and Illinois is seeking a Quality Initiatives Specialist for their MercyCare Insurance division. This role involves planning and conducting quality improvement activities related to behavioral and medical health initiatives, analyzing clinical quality measures, and leading various quality improvement projects.
Health CareNon Profit
Responsibilities
Acts as a lead specialist to provide project, program and /or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments
Assists in monitoring and analyzing outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met
Program and support Microsoft Access databases to manage targeted disease populations and provide efficiencies in work processes
Design and implement strategies for outcomes improvement based on membership population characteristics and business functions requirements
Participate in the implementation of Continuous Quality Improvement activities by contributing front line 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, and charting techniques
Complete Quality Initiative projects according to specifications and requirements. This includes: Following project policies and procedures. Accurate audit of measures. Data management: interfacing with and utilizing various software and portals for auditing and submitting data
Writing and updating policies and procedures
Provide follow up and education of providers and clinic staff on measures and project objectives.HEDIS / Quality Reporting
Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review
Assists Manager in training and takes the lead role in these activitiesAbstract data from the medical records and loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed
Works with the corporate HEDIS team to monitor accuracy of abstracted records as required by specifications
Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors
Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation
Provides data collection and report development support for quality improvement studies and performance improvement projects
Assists in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation
Qualification
Required
Bachelor's degree from a four-year college or university in related field or at least 5 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 the following Continuous Quality Improvement methodologies required: Qualitative and quantitative data collection, management, analysis, and reporting
Preferred
Certified Professional in Health Quality (CPHQ) or Registered Health Information Technician (RHIT) preferred
Benefits
Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.
Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.
Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.
Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.
Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.
Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.
Company
Mercyhealth Wisconsin and Illinois
At Mercyhealth, our doctors, nurses and staff are committed to making lives better for our patients and their families.
5001-10000 employees
H1B Sponsorship
Mercyhealth Wisconsin and Illinois has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2024 (5)
2023 (6)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Nathan Schultz
Chief Technology Officer
Shawn David
Chief Technology Officer / Chief Security Officer IMS Technical Director
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