Quality Improvement Specialist Senior
Core
Coordinate regulatory, accreditation, and clinical quality improvement programs to ensure compliance and improve healthcare delivery outcomes for members.
Role type
Senior Quality Improvement Specialist (Healthcare/Managed Care)
Builds
Quality improvement programs, compliance initiatives, and performance improvement projects
Domain
Healthcare, Managed Care, Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Complex project management, Vendor oversight, Program assessment and refinement, Cross-functional collaboration, Regulatory interpretation, Data reporting and presentation
Preferred skills
Clinical license, CPHQ certification, Medicare/NCQA experience
Technologies
HEDIS, CAHPS, NCQA, Medicare/Medicaid/CHIP/Marketplace
Responsibilities
Lead and manage complex initiatives impacting healthcare delivery quality; Ensure compliance with accreditation and federal/state requirements; Conduct assessments to refine activities and improve outcomes; Develop targeted activities to improve Star Ratings and performance measures; Research best practices and industry benchmarks; Collaborate with providers to improve clinical care outcomes.
Seniority
Senior, hands-on IC
