Senior Quality Improvement Specialist

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

📋 Description

• Oversee designated regulatory, accreditation, clinical quality, and/or service enhancement programs.

• Drive multiple extensive and intricate health services projects, while collaborating on national, regional, and multi-plan initiatives.

• Manage Medicaid state withholding and pay-for-performance initiatives.

• Create and track action plans at the measure level, including interventions, reporting, and financial implications.

• Ensure compliance of quality improvement programs with accreditation, and state and federal regulations.

• Evaluate programs, initiatives, and interventions, refining activities to boost effectiveness and outcomes.

• Handle vendor oversight and management responsibilities.

• Formulate targeted strategies to enhance Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction, and other performance metrics.

• Generate project communications, which include mailings, IVR scripts, emails, business plans, graphics, agendas, and minutes.

• Preserve quality improvement program documentation, evaluations, compliance audits, policies, procedures, and enhancement activities.

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

• Lead or engage in cross-functional committees and working groups.

• Identify opportunities for improvement and develop both clinical and non-clinical performance enhancement projects.

• Investigate best practices, benchmarks, and industry standards.

• Establish relationships with providers and provider organizations to foster quality improvement collaborations.

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

• Maintain external partnerships and evaluate industry trends and regulations for enterprise-wide implementation.

• Undertake additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor’s Degree or equivalent experience in 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.

• A minimum of three years of experience in a clinical/health care setting relevant to the degree program.

• Between three to five years of managed care experience in a health care environment.

• Experience in compliance, accreditation, service, or quality enhancement.

• Background in managing complex projects.

• Familiarity with Medicare and/or NCQA is preferred.

• Understanding of accreditation, regulatory, state, and federal standards.

• Ability to interpret contractual obligations and performance objectives.

• Experience in developing and monitoring action plans, interventions, reporting, and financial impacts.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

• Additional incentive programs may be included in the total compensation package.