medicaid managed care quality specialist.

Spherion, in partnership with the State of Wisconsin Department of Health Services, is looking for a Medicaid Managed Care Quality Specialist. This position will focus on quality improvement projects or initiatives within the Bureaus adult long-term care programs and acute and primary managed care programs.
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The Bureau administers managed care and waiver programs including the BadgerCare Plus and Medicaid SSI HMO programs, Family Care, Family Care Partnership, PACE, and IRIS. These programs serve adults with long-term care needs (including older adults and those with intellectual and developmental disabilities or physical disabilities) as well as acute and primary care populations (including most children, expecting women, childless adults, parents/caretakers, and most elderly, blind, or adults with disabilities in WI).
The Medicaid Managed Care Quality Specialist will have a role in strategy, operations, and analysis and will assist with federal quality requirements and program improvement efforts to ensure a high-quality, member-centered program with appropriate oversight of contracted plans.
Highlights:
- Idenfinite contract role
- Benefits: Medical, dental, and vision insurance, paid holidays, and PTO
- Schedule: Work from home, open to WI residents only!
Responsibilities:
- Continuing, revising, and/or retiring current Medicaid quality initiatives, projects, or measures based on data-driven recommendations, federal requirements, and the strategic goals of DMS for these programs
- Developing quality and performance measures for oversight of new initiatives or programs and ongoing program evaluations
- Analyzing and recommending performance measures, including both process and outcome measures, appropriate for the needs of the population, project, or program
- Developing and aligning financial or other incentives to drive quality improvement towards the DMS goals
- Analyzing data trends to identify program performance and outlier performance that may indicate best practices or compliance issues
- Developing and implementing reports, dashboards, visualizations, scorecards, public-facing quality website content, and/or data exchanges to support quality monitoring and quality improvement efforts
- Making policy and program recommendations based on quality data analysis and/or evaluation results
- Tracking best practices and innovative quality initiatives done in other markets or by other State Medicaid agencies
- Engaging with stakeholders, including DMS staff, external program evaluators, CMS, providers, members, managed care plans, and associations for feedback and technical assistance on quality initiatives
- Representing the DMS quality perspective in meetings, workgroups, projects, and/or external presentations
Working hours: 8:00 AM - 5:00 PM
Skills:
- Bachelors degree
Education:
Bachelors
Experience:
1-4 years
Qualifications:
The incumbent will be able to provide professional and technical support to manage the development and implementation of various initiatives within the Medicaid Quality Strategy and programs, including but not limited to, the following initiatives:
- Pay-for-Performance
- Core Set Measure Reporting to CMS
- Performance Improvement Projects
- Performance Improvement initiatives to address health disparities for expecting women
- HealthCheck performance reporting
- Member satisfaction and experience of care surveys
- Care management initiatives
- Initiatives to reduce emergency room utilization and potentially preventable readmissions
- Initiatives to identify, monitor, and address health disparities in served populations and/or address health-related social needs
Please apply for the Medicaid Managed Care Quality Specialist role today!

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At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).