QA QI Specialist

Universal Community Health Center•Los Angeles, CA

4d•Hybrid

About The Position

QAQI Specialist provides oversight of programmatic and interventional activities in accordance with contractual, regulatory requirements. QAQI professionals are ultimately responsible for guaranteeing the quality of products and services. Their day-to-day work involves careful inspections and the enforcement of quality standards from monitoring clinical and operational performance, analyzing data and outcomes, and conducting audits and chart reviews.

Requirements

College degree preferred, but not required if candidate has relevant work experience.
Relevant long-term experience, knowledge of regulatory requirements.
Knack for implementation of corrective action programs.
Experience in eCW preferred.
Superb computer competence, including experience with databases and Microsoft Office.
Knowledge of QA terms, tools, and methodologies.
Strong knowledge of quality assurance standards, regulatory compliance, and industry requirements.
Ability to interpret, document, and report on product or service quality metrics.
Experience with health risk assessments and patient monitoring protocols.
Proficient in data entry, tracking, and management using databases such as Google Sheets and electronic health record systems (e.g., eClinicalWorks).
Ability to monitor and upload data to IPA and payer portals and respond to insurance-driven requests.
Skilled in conducting chart audits, analyzing findings, and recommending corrective actions.
Competence in implementing corrective action plans and process improvements.
Strong organizational and administrative skills to coordinate office and clinic activities.
Ability to educate and advise patients within established medical parameters.
Competence in managing clinic inventory, medical supplies, and specialized equipment.
Excellent communication and triage skills for responding to patient questions via phone, fax, email, or mail.
Attention to detail and accuracy in documentation, reporting, and patient records.
Ability to work collaboratively with clinical teams to ensure quality and compliance.
Bilingual English/Spanish is required.

Responsibilities

Interpret and comply with quality assurance standards.
Ensure ongoing abidance by industry regulatory and quality requirements.
Documenting and reporting product or service quality levels.
Achieve a strong working knowledge of all company policies and procedures.
Collaborate with clinical, administrative, and leadership teams to improve workflows, patient outcomes, and service delivery.
Complete health risk assessments as necessary.
Monitor IPA data reporting requirements and upload all data to various IPA and payor data portals.
Monitor all payer portals and respond to all insurance-driven requests for data, working with the clinical team as necessary to complete data requests.
Conduct random chart audits for the clinical team.
Data entry, Answer, refer and/or follow-up via telephone, fax, email and mail with patient questions related to the program and specific needs of the patients.
Triage to the appropriate Care team.
Conduct random chart audits for the clinical team.
Maintains accurate documentation in google sheets or tracking logs.
Performs routine specialized procedures, such as setting up the iHealth products for the patients under established protocols.
Manages clinic inventories and medical supplies.
Educates and advises patients on specific medical issues within established parameters to include obtaining prescription information.
Directs patient flow following provider schedules/patient appointments.
Coordinates routine office activities and administrative functions to support clinic activities.
Assist with special projects, community health initiatives, and organizational improvement efforts aligned with UCHC.
Other duties assigned by the Senior Program Director.