Clinical Quality Mgmt Specialist I

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. 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. YOU belong here.

What awaits you:

• Work-life balance - This is a remote role! Applicants living in MD, DC, VA, PA, DE, or FL will be given first consideration.
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs and MORE!

What you'll do:

• The Clinical Quality Management Specialist (CQMS) is responsible for development and coordination of activities related to NCQA standards and reporting, as well as accountable for the clinical HEDIS measures and QualityImprovement initiatives and outcomes across the Health Services Department.
• Serve as a liaison supporting all clinical QI reporting as defined in the policies, procedures, line of business specific/ overall regulations, and accreditation standards.
• Work cross-functionally to identify data needs, analyze and synthesize data and information in order to articulate outcomes/findings in written reports to meet accreditation and other quality initiative standards.
• In conjunction with the QI, UM and CM Directors, you'll be responsible for coordination of clinical reporting to ensure meeting the quality and deadlines for all the necessary submissions within established time frames.
• Contribute to mental health and substance use disorder clinical programs and services.

What you'll bring:

• Bachelor’s degree in a healthcare related field such as Nursing, Public Health, or Health Care Administration.
• Knowledge of statistical reporting, with the ability to analyze data, summarize findings, and interpret the impact of quality improvement efforts.
• Working knowledge of National Committee for Quality Assurance (NCQA) standards, HEDIS, delegation oversight, audits, monitoring, and evaluation processes.
• Strong proficiency in Microsoft Office 365 applications, including Word, Excel, PowerPoint, and Outlook.
• Licensure as an RN (in MD or compact multi-state), LCSW (MD) or LMHC (MD) preferred. Certified Professional Healthcare Quality (CPHQ) or other health care quality certification preferred.
• 7+ years' of healthcare experience including 5+ years' in managed care environment and 2+ years' experience in an NCQA-accredited managed care organization with a focus on quality improvement or health services

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.