Senior Quality Improvement Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

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

• Spearhead multiple large-scale, intricate health services projects.

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

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

• Provide training and clarify policy, regulatory, and accreditation requirements.

• Lead initiatives aimed at enhancing the quality and effectiveness of healthcare delivery and member services.

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

• Conduct vendor management and oversight.

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

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

• Keep minutes and agendas.

• Engage in annual quality improvement program documentation and evaluations, compliance audits, policies, procedures, and improvement activities.

• Create internal progress reports and present them to senior-level staff.

• Outline outreach initiatives, challenges, and resolution efforts.

• Lead or engage in cross-functional committees and workgroups.

• Identify opportunities for organizational improvement and create clinical and non-clinical performance enhancement projects.

• Research best practices, benchmarks, and industry standards.

• Build relationships with contracted providers and provider groups to foster quality improvement collaborations.

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

• Maintain connections with external organizations and expand partnerships.

• Evaluate industry trends and regulations for enterprise-wide implementation.

• Perform additional assigned duties and adhere 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 such as MPH or MPA.

• At least three years of experience in a clinical/healthcare setting with a relevant degree program.

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

• Background in compliance, accreditation, service, or quality improvement.

• Experience in managing complex projects.

• Familiarity with Medicare and/or NCQA is preferred.

• Valid state clinical license is preferred.

• Certified Professional in Health Care Quality (CPHQ) is preferred.

• Must be able to reside in any state.

• Must work during EST hours.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase plans.

• Tuition reimbursement options.

• Paid time off in addition to holidays.

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

• Additional incentive options may be included in the overall compensation package.