• Quality Administrator Medicare - Michigan…

    McLaren Health Care (Flint, MI)


    We are looking for a Quality Administrator Medicare, to join us in leading our organization forward.

     

    McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

     

    McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.

     

    As an employee of MIG, 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.

     

    McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at

     

    https://www.mclarenhealthplan.org

     

    .

     

    MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at

     

    https://www.mdwise.org/

     

    .

    Position** **Summary:

    Responsible for delivering, strategizing, and improving quality performance with a focus on Medicare Star ratings. This position supports the design, development, implementation, and evaluation of quality programs focused on improving the plan’s Medicare Star ratings. This individual will collaborate with leadership and cross-functional teams to support the design and execution of quality-related projects and programs to advance organizational priorities related to quality performance. Responsible

     

    for

     

    proposing

     

    targeted

     

    actions,

     

    aiding

    in

    the development of the interventions and coordinating the implementation of all quality operations. Coordinates

     

    specific

     

    regulatory

     

    and

     

    contractual

    responsibilities

    including,

     

    but

     

    not

     

    limited to, HEDIS, CAHPS, HOS, and NCQA Standard compliance, performance projects, site audits, and any other regulatory requirements.

     

    This is a hybrid position with requirements to come onsite as scheduled, Flint, MI.

    \#LI-AK1

    Qualifications:

    Qualifications:

    Required:

    * Bachelor’s

     

    degree

     

    in

     

    health

     

    care,

     

    business

     

    or

     
     

    related

     

    field, or Associate’s degree and two (2) years’ related experience.

     

    * Two (2) years’ experience performing quality management activities in a Medicare managed care organization, including HEDIS, HOS, and CAHPS.

    Preferred:

    * Master’s

     

    degree

     

    in

     

    health

     

    care

     

    related

     

    field.

     

    * Four (4) years’ experience with a government regulated health organization or a managed care setting

     

    with

     

    at

     

    least

     

    three

     

    (3)

     

    years’

    experience

    performing

     

    complex

     

    quality

     

    management

     

    activities including HEDIS, NCQA etc.

     

    * In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.

    * Experience and knowledge of ICD-10, CPT I, CPT II, LOINC, SNOMED, HCPCS diagnosis and procedure coding, including billing requirements and guidelines.