AmeriHealth Caritas Quality Performance Specialist Non-Clinical in Southfield, Michigan

Quality Performance Specialist Non-Clinical


Your career starts now. We’re looking for the next generation of health care leaders.

At Blue Cross Complete of Michigan, we’re passionate about helping people get care, stay well and build healthy communities. Based in Southfield, Michigan, Blue Cross Complete is a subsidiary of Blue Cross Blue Shield of Michigan and AmeriHealth Caritas Health Plan. A managed health care organization licensed by the state of Michigan, Blue Cross Complete provides Medicaid health care services in 32 counties. Through the integrated care model of parent company AmeriHealth Caritas we partner with organizations to reduce health disparities and ensure access to the health benefits and services we provide.

We’re seeking talented, passionate individuals to join our team. If you want to make a difference, we’d like to hear from you. As a mission-driven organization, we deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care, community outreach, pharmaceutical benefit management and other administrative services.

Blue Cross Complete of Michigan is an independent licensee of the Blue Cross and Blue Shield Association. is one of the nation's leaders in health care solutions, offering associates the opportunity to impact the lives of millions of people through a national footprint of products, services and award-winning programs. Located in Philadelphia and operating in 17 states and the District of Columbia, AmeriHealth Caritas serves more than 5.7 million Medicaid, Medicare and CHIP members.

Job Summary:

This position is responsible for the coordination and ongoing monitoring of QI program objectives, including the delivery of performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments and facilitating HEDIS, CAHPS and NCQA accreditation activities. Implements and supports the overall implementation of quality programs that meet or exceed applicable State, Federal and NCQA standards.

Job Related Requirements Qualifications/Skills/Knowledge/Abilities: + Required Associate’s Degree or equivalent work experience. + Required Bachelor Degree preferred + Required minimum of 5 years experience in healthcare delivery required (Managed Healthcare experience preferred) + Required minimum of 3 years experience in clinical or service quality improvement + Preferred BSN/RN preferred not required + Preferred successful management of NCQA accreditation survey + Preferred two years managed Medicaid experience + Experience with Primary Source Verification, Road Map. Medical Records Review highly wanted