Senior Quality Improvement Specialist

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Oversee regulatory, accreditation, clinical quality, and service improvement programs assigned to you.

• Spearhead health services initiatives that involve multiple large-scale and complex projects.

• Collaborate on initiatives at national, regional, and multi-plan levels.

• Create programs that adhere to accreditation and regulatory standards while monitoring performance metrics.

• Act as a resource for training and interpreting policy, regulatory, and accreditation guidelines.

• Direct and manage initiatives that impact the quality and effectiveness of healthcare service delivery.

• Evaluate programs, initiatives, and interventions, making adjustments to enhance outcomes.

• Oversee vendor management and supervision.

• Design targeted initiatives aimed at boosting Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction, and other performance indicators.

• Generate project communications such as member/physician mailings, IVR scripts, emails, business plans, and graphics.

• Maintain documentation and evaluations for the annual quality improvement program, including compliance audits, policies, procedures, and improvement activities.

• Produce internal progress reports and present findings to senior management.

• Outline outreach initiatives, identify barriers, and detail resolution efforts.

• Lead or engage in cross-functional committees and working groups, preparing presentation materials as needed.

• Detect areas for improvement and collaborate across departments on clinical and non-clinical performance enhancement projects.

• Investigate best practices, benchmarks, and industry standards.

• Cultivate relationships with providers and provider groups to further quality improvement collaborations.

• Participate in external activities, workgroups, or committees when relevant.

• Communicate programs, interventions, and outcomes to external stakeholders.

• Maintain relationships with external organizations and broaden partnerships.

• Analyze industry trends and regulations for enterprise-wide application.

• Execute other assigned tasks while adhering to policies and standards.

⛳️ Requirements

• Bachelor’s Degree or equivalent experience with a clinical license, or a Master’s Degree in a related health field (e.g., MPH or MPA).

• Valid state clinical license is preferred.

• Certification as a Professional in Health Care Quality (CPHQ) is preferred.

• At least three years of experience in a clinical or healthcare setting related to the degree program.

• Three to five years of managed care experience in a healthcare environment.

• Experience in compliance, accreditation, service, or quality improvement processes.

• Experience managing complex projects.

• Familiarity with Medicare and/or NCQA is preferred.

• HEDIS Operations experience is highly desired.

• Experience in Clinical Medical Record Review.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to 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.