Quality Care Improvement Specialist II
About The Position
The Quality Care Improvement Specialist II develops, recommends, and implements interventions at the practice and membership level to improve quality and operational efficiency. This role collaborates with practices to facilitate redesign efforts, support care teams, introduce population health management, and support achievement towards improved financial, operational processes, and clinical outcomes. The Specialist serves as a key liaison to lead and coordinate initiatives that drive performance in HEDIS, CMS Star Ratings (Part C), Managed Medicaid, Commercial, and additional health plan quality metrics.
Requirements
- Bachelor’s degree or equivalent experience
- 3–5 years of experience in healthcare, ideally in IPA/MSO/Health Plan environments
- Minimum of 1 year of HEDIS-related experience
- Strong knowledge of managed care and quality program standards
- Excellent analytical, communication, and presentation skills
- Demonstrates initiative, creativity, and a collaborative mindset
Nice To Haves
- Fluent in Spanish and/or Portuguese
- Familiar with practice management and financial operations
- Adaptable, self-motivated, and eager to grow within a mission-driven organization
- Highly organized, detail-oriented, and capable of managing multiple priorities in a dynamic environment
- Experienced in outpatient clinical settings
Responsibilities
- Partner with provider practices onsite and remotely to improve performance on quality care measures, focusing on practice transformation and population health management
- Collect, review, and validate medical records to ensure accuracy and completeness for reporting purposes
- Analyze provider performance data, identify trends, and deliver targeted education to drive improvements
- Provide in-service training to primary care providers and office staff on quality metrics, incentive programs, and documentation integrity
- Support project implementation aimed at enhancing service delivery, patient outcomes, and care experience
- Guide practices through sustainable process improvements, including team building, leadership development, and operational redesign
- Lead, mentor, and guide the Quality Care Improvement Specialist team to achieve performance and quality goals
- Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards
- Develop and execute set of intervention work plans to drive practice and improve quality measures and transformation
- Develop and implement workflow design and redesign, including electronic health record (EHR) optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting
- Conduct comprehensive training for PCPs and specialists on Quality Measures, HEDIS and CMS Star Ratings, Performance-Based Incentive Programs, Data Accuracy and Documentation Standards
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
