Market Clinical Quality Specialist II

Job Summary: Market Clinical Quality Specialist III is responsible to manage monthly, quarterly, and annual reporting requirements for both Quality and Integrated Care teams. Essential Functions: Assist in development and provide data for maintenance of Metric Dashboards for Quality Teams Identify departmental development opportunities and work collaboratively with peers to develop the needed education Assist leadership with development and maintenance of policies, procedures, and quick tools Develop quarterly and annual reports Assist Leadership with reporting of case reviews that can be communicated at overall aggregate and individual levels Develop and maintain tracking of Quality Audits being conducted by Clinical Management and Enterprise Quality Improvement (QI) to report trending and compliance Research, gather, and analyze data to determine quality scoring for internal and delegate teams Assist with tracking, compiling, and reporting program quality metrics Complete queries in CareStar system and analyze reports to assist with completion of Monthly Delegation Oversight Scorecard metrics Aggregate Quality Raw Data Scores Monthly Complete monthly process for randomized reporting of member cases to be audited Develop and maintain monthly exception reporting to determine areas of opportunity for Quality & Delegation Oversight Teams to focus on Schedule and plan quarterly Joint Operating Committee meetings Assist with maintenance and User Acceptance Testing (UAT) for SharePoint and Onbase databases and workflows Develop and present reporting for monthly QI/QM meeting Perform any other job duties as requested Education and Experience: Associates degree in business, health administration, health policy or related discipline or equivalent years of relevant work experience is required A minimum of five (5) years of Managed Care or Healthcare Administration experience is required Experience in Quality Improvement, Case Management or Utilization Review is preferred Competencies, Knowledge and Skills: Intermediate in Microsoft Excel, Access, and Word Intermediate skill level with SharePoint PowerPoint and Visio preferred Strong written and verbal communication skills Ability to work independently and within a team environment Familiarity of the healthcare field Knowledge of Medicaid and Medicare Effective listening and critical thinking skills Strong interpersonal skills and high level of professionalism Effective problem-solving skills with attention to detail Ability to develop, prioritize and accomplish goals Technical writing skills Ability to coordinate complex projects and multiple meetings Ability to work with a variety of disciplines and levels of staff across departments Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Organization Level Competencies Leveraging Feedback Customer Orientation Valuing Differences Managing Work Earning Trust Quality Orientation Adaptability Influencing Collaborating This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.