Quality Improvement Specialist
About The Position
Under the direction of the Director, Provider Relations, the Quality Improvement (QI) Specialist supports healthcare quality initiatives by managing Annual Wellness Visits (AWV) and Health Effectiveness Data and Information Set (HEDIS) activities, analyzing performance data, and coordinating improvement efforts with internal teams and providers. This role monitors quality measures, identifies opportunities to enhance outcomes, and ensures compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state regulatory standards. The Specialist prepares reports and dashboards, conducts root cause analysis, facilitates provider education, and supports the execution of Quality Improvement Plans. Additional duties may be assigned.
Requirements
- Bachelor’s Degree in Healthcare Administration, Nursing, Public Health, Business, or a related field required
- Equivalent combination of education and experience may be substituted for the Bachelor’s Degree requirement.
- 3 years of experience working with HEDIS measures, Medicare Risk Adjustment, or related required
- Experience interpreting technical data specifications, performing research, and applying critical thinking to quality related data required.
- Demonstrated experience with EHR systems and data aggregator platforms; Quality metrics, performance monitoring, and reporting; and Project management within a healthcare or quality improvement environment required.
Responsibilities
- Managing Annual Wellness Visits (AWV) and Health Effectiveness Data and Information Set (HEDIS) activities
- Analyzing performance data
- Coordinating improvement efforts with internal teams and providers
- Monitoring quality measures
- Identifying opportunities to enhance outcomes
- Ensuring compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state regulatory standards
- Preparing reports and dashboards
- Conducting root cause analysis
- Facilitating provider education
- Supporting the execution of Quality Improvement Plans
- Additional duties may be assigned.
Benefits
- Tuition reimbursement, education programs, and scholarships
- Vacation time starts building on Day 1, and builds with your seniority
- Free money toward retirement with a 403(b) and matching contributions
- Commitment to diversity and inclusion is a cornerstone of our culture at Community.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1,001-5,000 employees
