Quality & PI Specialist
About The Position
The Quality & Performance Improvement Specialist supports the California market's Quality and Performance Improvement activities related to direct care management services and oversight of subcontracted care management providers. This position is responsible for coordinating quality initiatives, analyzing performance data, monitoring trends, supporting corrective action activities, and facilitating continuous quality improvement efforts across the organization and subcontracted provider network. The Quality & Performance Improvement Specialist collaborates with operational, clinical, compliance, and provider network teams to support high-quality, compliant, member-centered care management services. This role focuses on quality performance monitoring, process improvement, provider support, reporting, and regulatory readiness rather than direct auditing activities.
Requirements
- Bachelor’s degree in Nursing, Healthcare Administration, Public Health, nursing, social work, quality management or a related field.
- Minimum of 3 years of experience in healthcare quality improvement, managed care, care management, healthcare operations, or related healthcare environment.
- Experience supporting quality improvement initiatives, performance management, or provider oversight activities.
- Strong knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies.
- Strong analytical, organizational, and problem-solving skills.
- Experience working with healthcare data, reporting, and performance metrics.
- Proficiency with Microsoft Office applications, especially Excel and PowerPoint.
- Excellent written, verbal, and interpersonal communication skills.
- Relevant experience may substitute for educational requirement on a year-for-year basis.
Nice To Haves
- Master’s degree in Healthcare Quality, Public Health, or a related discipline.
- Experience with Medicaid/Medi-Cal managed care, care coordination, or population health programs.
- Familiarity with delegated provider oversight or subcontracted provider network management.
- Knowledge of healthcare quality improvement methodologies and regulatory requirements.
- Certification in Quality Improvement or Patient Safety (e.g., CPHQ - Certified Professional in Healthcare Quality).
Responsibilities
- Demonstrates commitment to Our Mission and consistently models the ILS Experience Standards of Excellence.
- Supports the implementation, coordination, and continuous improvement of the organization's Quality Improvement and Health Equity programs by assisting with quality initiatives, performance improvement projects, workplans, and organizational objectives.
- Monitors quality metrics, performance indicators, operational trends, and provider performance to identify opportunities for improvement, coordinate corrective actions, and support achievement of organizational quality goals.
- Serves as a liaison to subcontracted providers by supporting provider performance improvement, monitoring contractual and regulatory compliance, coordinating follow-up activities, and promoting adherence to quality standards and organizational expectations.
- Compiles, validates, analyzes, and interprets quality and operational data from multiple sources while developing dashboards, scorecards, reports, summaries, and presentations that support operational and executive decision-making.
- Assists in the development, implementation, maintenance, and revision of quality-related policies, procedures, workflows, documentation, and operational standards to promote consistency, compliance, and operational effectiveness.
- Works collaboratively with clinical, operational, compliance, provider network, and other interdisciplinary teams to support organizational quality initiatives, performance improvement efforts, and member-centered care.
- Maintains accurate records, monitors quality activities, tracks action items, and demonstrates accountability by ensuring timely completion of assignments, follow-up activities, and organizational commitments.
- Supports the development and delivery of quality education, training materials, and communications that promote understanding of quality expectations, performance standards, regulatory requirements, and improvement initiatives.
- Supports compliance with applicable federal, state, health plan, accreditation, and organizational requirements by assisting with audits, delegated oversight activities, regulatory reviews, and monitoring quality-related corrective action plans.
- Performs other duties as required or assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
