Quality Improvement Specialist Senior
Core
Lead Medicaid state withhold and pay-for-performance programs, ensuring compliance with accreditation and regulatory standards while driving quality improvement initiatives for health care delivery.
Role type
Senior Quality Improvement Specialist (Healthcare/Medicaid)
Builds
Medicaid state withhold and pay-for-performance programs, quality improvement initiatives, and compliance frameworks
Domain
Healthcare, Medicaid, Managed Care, Regulatory Compliance
Required skills
Project management, Vendor oversight, Performance measure development, Regulatory compliance, Cross-functional collaboration, Data reporting, Program evaluation, Stakeholder management, Strategic planning, Change management
Preferred skills
Clinical license, CPHQ certification, Medicare/NCQA experience, Master's in Health field
Technologies
HEDIS, CAHPS, HOS, Star Ratings, IVR systems, Compliance audit tools
Responsibilities
Lead and manage complex health care quality initiatives; Ensure program compliance with accreditation and federal/state requirements; Develop targeted activities to improve performance measures (Star Ratings, HEDIS, CAHPS); Conduct assessments to refine activities and improve outcomes; Manage vendor relationships and oversight; Develop internal reports and present to senior leadership; Collaborate with cross-functional teams and external provider groups; Research industry benchmarks and best practices.
Seniority
Senior, hands-on IC with strategic leadership
