Quality Improvement Specialist NCQA - Denver Health Medical Plan ( Weekly Hybrid Schedule Requirement )

Denver Health•Denver, CO

23h•Hybrid

About The Position

The Quality Improvement (QI) Specialist supports the design, implementation, and evaluation of quality initiatives that enhance member outcomes, strengthen provider performance, and ensure compliance with regulatory requirements. This role is critical in advancing health plan performance across HEDIS, Medicare Stars, CAHPS, and Colorado Medicaid quality programs, while supporting NCQA accreditation and other compliance activities. The QI Specialist collaborates with cross-functional teams and external stakeholders to drive measurable improvements in clinical care, operational processes, and member experience.

Requirements

Bachelor's Degree Public Health, Nursing, or related field required
4–6 years’ experience in health plan quality improvement, with direct experience in HEDIS and Stars required
CPHQ-Certified Professional Healthcare Quality - NAHQ - National Association for Healthcare Quality
GREENBELT-Green Belt - SSGI - Six Sigma Global Institute
Familiarity with Colorado Medicaid quality programs, HCPF requirements, and EQRO processes.
Demonstrated knowledge of NCQA accreditation standards, CMS requirements, and managed care operations.
Strong data analysis and reporting skills (Excel required; Tableau, SAS, or other tools preferred).
Excellent communication and project management skills with ability to influence cross-functional teams.
Strong Verbal and written skills

Responsibilities

Ensure compliance with HCPF quality requirements, including performance improvement projects (PIPs), External Quality Review Organization (EQRO) reporting, and population health initiatives.
Support National Committee for Quality Assurance: (NCQA) accreditation readiness and regulatory audits by maintaining accurate documentation and work plans. Stay current on Centers for Medicare & Medicaid Services (CMS), NCQA, and Health Care Policy and Financing (HCPF) guidelines.
Partner with care management, pharmacy, and provider networks to design and implement quality interventions that improve outcomes and reduce disparities.
Apply quality improvement methodologies (e.g., PDSA, Lean, Six Sigma) to evaluate workflows, streamline processes, and enhance operational efficiency.
Collect and analyze feedback (CAHPS, surveys, advisory groups) to inform strategies that improve access, coordination, and satisfaction.
Develop dashboards, reports, and presentations for leadership, committees, and external stakeholders, ensuring accuracy and timeliness.
Facilitate or support quality committees, workgroups, and cross-departmental projects focused on clinical and operational improvement.

Benefits

Generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs.
Tuition assistance, career advancement pathways, and professional development.
Loan forgiveness eligibility and employer contributions.
Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer