Quality Improvement Specialist II

This is a fully remote position, open to applicants in Arizona, +1 more state.

📋 Description

• Provide support for daily operations within the Quality Improvement department.

• Oversee the HEDIS project, including nurse assignments, adherence to the project timeline, and vendor management to ensure quality and timeliness.

• Facilitate data collection, data entry, and the generation of reports for Quality Improvement initiatives.

• Support studies on access and availability, manage HEDIS abstraction forms, conduct medical records/site reviews, and participate in member and physician satisfaction studies.

• Analyze data and prepare reports for discussion in committee meetings.

• Conduct research and create newsletters and educational materials for providers.

• Carry out interdepartmental inter-rater reliability audits.

• Design, implement, and manage data review processes to ensure accuracy and integrity of reports.

• Execute process improvements to enhance departmental operations.

• Assist the Director of Quality Improvement during audits from regulatory agencies and review organizations.

• Perform additional duties as assigned.

• Adhere to all relevant policies and standards.

⛳️ Requirements

• An Associate’s degree in a related field or equivalent experience.

• A minimum of 4 years of experience in data management within a health insurance organization.

• Demonstrated experience in a role with responsibility for report generation management or project management.

• Proficient in MS Office applications.

• Candidates must be residents of Arizona or Nevada.

• Previous experience with Managed Care Organizations (MCO), Quality Management/Improvement, and HEDIS is preferred.

• Familiarity with quality initiatives, including HEDIS projects, study analysis, or NCQA standards is preferred.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off.

• Holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.

• An equal opportunity employer dedicated to diversity.