Quality Improvement Specialist

Mass General Brigham•Somerville, MA

3d•Remote

About The Position

The Quality Project Management Specialist is responsible for coordinating and managing projects aimed at improving the quality of care, ensuring compliance with regulatory standards, and enhancing member satisfaction within the health plan. This role involves the development, implementation, and evaluation of quality improvement initiatives, working closely with cross-functional teams to achieve organizational goals. The Specialist will oversee and lead projects from initiation to completion, ensuring that they are completed on time, within scope, and on budget. The role requires a strong understanding of project management methodologies, processes, and tools; driving project teams, coordinating resources, and is the primary point of contact for stakeholders.

Requirements

Bachelor's Degree Related Field of Study required (experience can be substituted in lieu of degree)
At least 2-3 years of experience in Quality Improvement, preferably in a healthcare setting required
Strong understanding of document management systems (DMS), such as SharePoint, OpenText, or Documentum, to manage digital files, track revisions, and maintain version control.
Familiarity with cloud storage systems and collaboration tools like Google Drive, Dropbox, and Microsoft OneDrive.
Experience with electronic records management (ERM) and data retention policies.
Demonstrates awareness of importance of security, scalability, reliability and feasibility in solutions
Seeks out information to better understand impacts of design and implementation of systems
Evaluates service areas to identify opportunities for automation
Ability to draft, revise, and implement company policies and standard operating procedures.
Knowledge of compliance standards, including industry-specific regulations (e.g., healthcare HIPAA regulations, financial regulations, state and federal rules).
Strong organizational skills to ensure policies and documents are properly filed, categorized, and easy to access.
Breaks complex topics into meaningful chunks of information.
Seeks out multiple sources to gather information.
Understanding of legal and regulatory requirements for document retention and management, including data privacy and security laws.
Knowledge of audit procedures and the ability to prepare documentation for audits.
Excellent written and verbal communication skills for drafting policies and procedures, as well as providing guidance to employees about document handling and compliance.
Ability to train staff on document management practices and policy changes.
Experience using document management software and workflow tools to streamline document processes and improve efficiency.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and other productivity tools is often required.
Familiarity with document control software for versioning, workflow management, and access permissions.
Ability to manage multiple tasks or projects simultaneously, adhering to deadlines and ensuring that policies and documents are up to date.
Experience with project management software, such as Trello or Microsoft Project, is beneficial.
Ability to identify issues with document flow, retention, or compliance and propose solutions to resolve them.
Strong critical thinking skills for analyzing policies and procedures to ensure they align with organizational goals and legal requirements.
Excellent interpersonal skills, including the ability to influence others at all levels of an organization.

Nice To Haves

Master's degree preferred
Project Management Professional (PMP) certification preferred
Certification in healthcare quality or equity (e.g. CPHQ, CPHE, Lean Six Sigma, etc.) preferred
At least 5 years in health plan quality in a managed care organization highly preferred
At least 3 years in project management highly preferred
Experience in healthcare quality, health equity initiatives, population health, or related program coordination highly preferred
Familiarity with QI methodologies and regulatory standards highly preferred

Responsibilities

Lead and manage multiple quality improvement projects across the health plan, ensuring they are completed on time, within scope, and meet the organization’s objectives.
Develop project plans, timelines, budgets, and resource allocations, adjusting as necessary to ensure project success.
Monitor project progress and identify risks, issues, or delays, implementing corrective actions as needed.
Communicate regularly with internal and external stakeholders to ensure expectations are managed, issues are addressed, and the project is on track
Work with cross-functional teams, ensuring that roles and responsibilities are clearly defined and progress is tracked.
Proactively identify and mitigate project risks and issues, adjusting plans as necessary to ensure project success.
Monitor and control project budgets, ensuring resources are used efficiently and effectively.
Ensure that deliverables meet the required quality standards and stakeholder expectations.
Provide regular status updates and detailed reports to leadership and stakeholders, documenting all project activities, milestones, and changes.
Drafting, reviewing, and revising internal policies and procedures to ensure alignment with industry standards, legal requirements, and best practices.
Support quality improvement (QI) projects using methodologies such as PDSA, Lean, or Six Sigma.
Support the development and implementation of health plan quality improvement initiatives focused on improving clinical outcomes, operational efficiency, and customer satisfaction.
Monitor and analyze health plan performance data to identify areas for improvement, developing actionable insights and solutions.
Collaborate with clinical teams, operations, and IT to ensure quality metrics are met, and quality programs are integrated across the health plan.
Ensure that quality projects align with state and federal regulations, such as CMS (Centers for Medicare & Medicaid Services) standards, NCQA (National Committee for Quality Assurance) requirements, and other applicable regulatory frameworks.
Monitor and support audits and reporting requirements related to quality measures and performance metrics.
Collect, analyze, and interpret data related to health plan quality, including clinical, operational, and member satisfaction data.
Prepare and present reports on project progress, outcomes, and key performance indicators (KPIs) to senior leadership and stakeholders.
Other duties as assigned