Quality Case Manager (RN or LSW Preferred)

Company : CommuniCare Family of Companies

Location : Ohio City, OH, 45874

Posted Date : 18 October 2025

Job Type : Other

Category : Community & Social Service

Occupation : Case Manager

Job Details

Job Address:
10123 Alliance Road, Suite 320Blue Ash, OH 45242
CommuniCare Advantage is currently recruiting a Quality Case Manager for our Medicare Advantage Plan. RN or LSW strongly preferred.
Purpose/belief statement:
The Quality Case Manager position is a support role, reporting to the Director of Health Plan Quality. The QI CM will support interventions and initiatives that promote an ongoing environment of quality. The QI CM will be able to work collaboratively with cross-functional teams to ensure comprehensive approaches and interventions support the Model of Care and QI Program in compliance with all state, federal and CMS regulations.
Job duties & responsibilities:
Works in conjunction with the Director of Health Plan Quality to perform clinical auditing, map out workflows, work plans, interventions, and other activities necessary to support the Quality strategy of the Plan including:

MOC audits, processes, interventions
Quality Improvement projects
HEDIS & Star measure evaluation and interventions
Member surveys (CAHPS, NPS)
Other QIC activity

Qualifications & Experience requirements

Bachelor's degree in healthcare, and/or business; RN or Licensed SW strongly preferred.
Minimum of 3-5 years' experience in Quality Improvement and/or process engineering, especially in a clinical or health plan setting.
Knowledge of Medicare Advantage quality requirements and benefits, with emphasis on Special Needs Plans (SNP).
Experience in data analysis preferred. Highly functional with Excel and data reporting.
Ability and experience utilizing a variety of applications and databases to fulfill care management coordination requirements/documentation

Knowledge/Skills/Abilities
Knowledge:

Knowledge of CQI principles, practices, methods, and tools.
Knowledge of computer applications related to QI, including spreadsheets.
Knowledge of medical records and clinical care processes.
Proficiency with a variety of data applications.
Excellent interpersonal communication, written, and organizational skills required.
Microsoft Office/Suite proficient (Excel, PowerPoint, Word, Visio, etc.)

Skills:

Skill in effective education and facilitation of CQI efforts in medical practice.
Skill in application of analytical methods and statistical software by developing appropriate reports.
Skill in conducting QI checks of medical records and other clinical documentation and performing patient satisfaction surveys.

Abilities:

Ability to educate staff in both verbal and written form, especially about QI in formal and informal settings.
Ability to interact effectively with health care team members.
Ability to analyze QI data and identify trends and corrective actions.
Must be equally comfortable and competent in working with clinical and non-clinical staff
Must have integrity and a strong ethical compass.

Must be flexible, able to work independently, and able to achieve deadlines and deliverables with minimal supervision.
Must have strong communication skills and the ability to work effectively with people coming from diverse cultural and professional perspectives.