Medicare Quality Administrator - Michigan Residency Required

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.

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Qualifications:

Required:
•    Bachelor’s degree in health care, business or a 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.