Quality Performance Specialist

Amerihealth Caritas•,

22h•Hybrid

About The Position

The Quality Performance Specialist is responsible for coordinating, monitoring, and supporting Quality Improvement (QI) program objectives and performance improvement initiatives. This role drives organizational quality outcomes through the implementation of quality programs, performance monitoring, regulatory compliance activities, and accreditation support. The specialist partners across departments to integrate quality improvement strategies, facilitate Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®), and National Committee for Quality Assurance (NCQA) activities, and ensure compliance with state, federal, and accreditation standards.

Requirements

Associate's degree or equivalent combination of education and relevant work experience required.
Experience working in a high-volume, performance-driven healthcare environment while maintaining regulatory compliance.
Knowledge of critical incident reporting requirements and Office of Long-Term Living (OLTL) regulations.
Experience using Enterprise Incident Management systems.
Advanced Microsoft Office proficiency.
Ability to accurately enter, manage, and analyze data while maintaining data integrity.

Nice To Haves

Bachelor's degree preferred.
Minimum of three (3) years of experience in Quality Improvement, Healthcare Quality, Clinical Operations, Population Health, Managed Care, or Healthcare Service Delivery preferred.
Managed Care Organization (MCO) experience preferred.

Responsibilities

Support and execute organizational Quality Improvement (QI) initiatives to ensure compliance with state, federal, regulatory, and accreditation requirements.
Analyze annual HEDIS results and collaborate with cross-functional teams to incorporate findings into departmental goals and performance strategies.
Facilitate the development, implementation, and evaluation of the annual QI Work Plan and Program Description.
Identify, address, and escalate quality-related risks that may impact achievement of organizational quality goals.
Partner with Provider Services and Member Services teams to analyze member and provider satisfaction survey results and integrate findings into improvement plans.
Develop, implement, and maintain Quality Improvement policies, procedures, and best practices.
Serve as a subject matter resource for departments working toward quality improvement objectives.
Collaborate with stakeholders at all levels of the organization to support quality, service, and operational excellence initiatives.
Participate in Quality Improvement committees and ensure documentation meets regulatory and accreditation standards.
Support continuous performance improvement activities through data analysis, reporting, and process optimization.