Operational Excellence Specialist

C2Q Health Solutions•New York, NY

1d•$55,000 - $65,000

About The Position

Under the direction of the A&G Manager/Senior Shared Services Manager, the Operational Excellence Specialist supports accuracy, consistency, timeliness, and continuous improvement of Shared Services operations within the PACE program. The Specialist conducts quality reviews of operational cases, documentation, and participant correspondence; delivers staff training; and helps translate review findings into practical process improvements. Working with Shared Services leadership, Quality, Compliance, and the Interdisciplinary Team, among others, this role promotes participant-centered service, complete documentation, and adherence to approved procedures and applicable requirements.

Requirements

Associate's degree in business, health care, or a related field, or equivalent.
At least one year of experience working with a frail or elderly population. If the individual has less than one year of experience but meets all other requirements, appropriate training from the PACE organization or related industry on working with a frail or elderly population must be provided upon hiring.
Experience in healthcare, Medicare and Medicaid, CMS guidelines, customer experience, quality review, and appeals and grievances.
Experience using electronic medical records, case tracking systems, customer relationship management systems, or similar documentation platforms.
Excellent written and verbal communication skills, including grammar, spelling, and punctuation.
Ability to thrive in a fast-paced environment and meet assigned deadlines.
Excellent organizational skills, accuracy, and attention to detail.
Demonstrated ability to manage multiple projects and be flexible.
Ability to work independently and collaboratively as required.
Proficiency in Microsoft Office, including Word, Excel, and Outlook.
Fluency in English.
Ability to meet the stated physical requirements, including standing, sitting, lifting or pushing/pulling up to 50 pounds, bending or squatting, using stairs and walking, operating equipment and tools with fine motor skills, reading and writing accurately, listening and communicating clearly, and demonstrating sound cognitive judgment and analysis.

Nice To Haves

Bilingual ability.

Responsibilities

Conduct routine, targeted, and risk-based reviews of transactions, work queues, case records, and supporting documentation using approved tools and sampling methods.
Review assigned cases from intake through closure for accuracy, completeness, timeliness, correct routing, documented follow-up, and adherence to approved workflows and applicable PACE requirements.
Document findings objectively, distinguish isolated errors from recurring process issues, and coordinate corrections with responsible case owners.
Maintain review logs, track remediation, and perform follow-up reviews to confirm effective corrections.
Participate in calibration sessions to support consistent review standards.
For the SDR / Appeals and Grievances Unit only, review participant and authorized representative letters before release for accurate recipient information, dates, case details, approved templates, readability, and consistency with documented decisions.
Verify required notice elements, applicable timeframes, language and accessibility needs, and delivery documentation using Compliance, NYDOH, and CMS-approved criteria.
Promptly escalate participant-rights concerns, overdue actions, privacy issues, and significant quality risks.
Refer clinical judgments, service determinations, and legal or regulatory interpretations to authorized personnel; do not independently change clinical decisions or approved notice language.
Develop and deliver onboarding, refresher, and process-change training; provide process-focused coaching on documentation, correspondence, workflows, and system use.
Develop training decks and keep them updated with operational changes.
Maintain approved procedures, job aids, checklists, letter-review guides, and training materials with process owners, including version control and distribution.
Use identified cases and recurring findings in practical learning activities.
Track attendance and completion and assess training effectiveness through knowledge checks and post-training quality trends.
Analyze quality findings, repeat errors, rework, turnaround times, and bottlenecks; support root-cause analysis, process mapping, corrective action plans, and small-scale improvement tests.
Report review volumes, error categories, recurring themes, remediation status, and improvement outcomes to leadership.
Support audits and monitoring by organizing review evidence, training records, procedures, and corrective action documentation.
Protect confidential information and follow privacy, security, and records-management policies.