Quality Improvement - Critical Incident (Medicaid/Medicare)

Location: Remote nationwide within the United States; Monday–Friday, typically 8:00 a.m.–5:00 p.m. Central Standard Time. Occasional travel to hirify.global offices for training or meetings may be required.

Salary: $65,000–$88,600 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and insurance company serving Medicare and Medicaid members, families, individuals, and communities.

What you will do

• Review new critical incident entries and determine whether they meet Illinois oversight guidelines.
• Monitor care coordination activity and documentation, collaborating with Care Coordinators to mitigate member risk.
• Coordinate with leadership on incident closure and provide oversight for quarterly state audits.
• Prepare monthly reports for the state, reports for the Illinois Quality Improvement Committee, and support the annual quality report.
• Conduct compliance and quality audits, root cause analysis research, and reviews of internal quality metrics.
• Support process improvement initiatives, training, education, and updates to job aids and policies.

Requirements

• Bachelor’s degree.
• At least two years of experience in process improvement, compliance measures, auditing practices, or Medicaid/Medicare care coordination.
• Experience in care coaching and/or care coordination.
• Strong oral, written communication, and presentation skills.
• Excellent analytical skills, including the ability to manipulate and interpret data.
• A dedicated home workspace is required to protect member PHI and HIPAA information; internet service must provide at least 25 Mbps download and 10 Mbps upload.

Nice to have

• Knowledge of critical incident reporting.
• Experience with Medicaid or Medicare guidelines.
• Comfort working with tight deadlines in a fast-paced environment.

Culture & Benefits

• Remote work with occasional office travel for training or meetings.
• Medical, dental, and vision coverage.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and other well-being benefits.