Job Description

Job Title: Quality Improvement Specialist

About Us: We are dedicated to improving the quality of healthcare and patient experiences. Our mission is to ensure that everyone receives the highest standard of care, regardless of their background or abilities. We welcome applicants from all backgrounds, including elderly individuals, refugees, people with disabilities, LGBTQIA+ individuals, veterans, and more. Your unique perspective and experience will enrich our team.

Role Overview:

The Quality Improvement Specialist plays a crucial role in conducting, coordinating, and monitoring quality activities and initiatives for our Health Plan. This includes evaluating member and/or patient care services, recommending improvements, and ensuring compliance with regulatory requirements. Your efforts will contribute to enhancing our performance measures, HEDIS/QARR, Star ratings, and Incentive programs.

Responsibilities:

• Develop performance measures, design data collection tools, and conduct quality, compliance, and utilization reviews.
• Ensure our Quality Improvement programs align with the CMS Triple Aim framework, improving patient experiences, population health, and reducing healthcare costs.
• Analyze data, identify trends, prepare reports, and present findings to committees, managers, and staff.
• Participate in QM Committees and subcommittees, contributing to discussions and decision-making processes.
• Collaborate in the coordination, review, and approval of policies and procedures, addressing gaps and proposing new policies when needed.

Qualifications:

• Bachelor's degree in Healthcare Administration, Public Health, Business, or a related healthcare field. Master's degree preferred.
• Minimum of three years of experience in quality improvement within a health plan or healthcare setting.
• Ability to work independently, autonomously, and with self-motivation.
• Excellent oral, written, and interpersonal communication skills, including the ability to facilitate group discussions.
• Basic knowledge of Performance Improvement tools and methodologies preferred.
• Experience with medical record collection, including utilizing supplemental data sources, vendors, EMR remote collection, and occasional visits to provider and clinical offices.

If you believe in our mission and are passionate about improving healthcare quality, we invite you to apply for this position.

Application Requirements:

• Please complete the application form on our website, providing your contact information, educational background, and work experience.
• Attach your resume and any relevant certifications or licenses.
• Include a cover letter expressing your interest in the role and how your skills and experience align with our mission.
• Applications will be accepted until [deadline].

As an equal opportunity employer, we celebrate diversity and are committed to creating an inclusive and accessible workplace. If you require any accommodations during the application process, please let us know.

Thank you for considering joining our team. We look forward to reviewing your application.

Sincerely,

[Your Name]

[Your Title/Position]