Quality Improvement Specialist Jobs

About The Position

Requirements

• Willingness and ability to travel daily, up to 100%, to provider practices and patient homes to perform scheduled eye exams.
• Must have a valid driver’s license and reliable transportation.
• Associate degree or greater in a related field.
• Minimum of 1–3 years of experience in a healthcare setting.
• Minimum of 2 years of experience supporting Medicare Advantage, Commercial, Medicaid, or MSSP quality programs, including data abstraction and patient outreach.
• Experience working with EMR systems, medical records, health data, chart review, or data abstraction workflows.
• Knowledge of medical terminology, quality measures, medical billing, or coding.
• Proficiency using Microsoft Excel, PowerPoint, Word, Outlook, Teams, and multiple healthcare-related systems or applications.
• Strong verbal and written communication skills.
• Strong attention to detail, organizational skills, and ability to meet hard deadlines.
• Ability to collaborate effectively with management, co-workers, customers, providers, payers, and care teams.
• Ability to work independently in a remote environment.
• Must reside locally in the Houston, TX area.
• Must be accessible during stated working hours and join virtual meetings with cameras on.

Nice To Haves

• Certified or licensed healthcare professional credential, such as Certified Medical Assistant (CMA) or Licensed Practical Nurse (LPN).
• Experience with quality improvement initiatives and data submissions required by health insurance payers.
• Experience with Medicare Advantage STAR, Medicaid, Commercial, and/or MSSP ACO quality programs.
• Experience with NCQA/HEDIS®, CMS, MSSP, or payer-specific quality measure specifications.
• Experience with quality database entry, reporting, and performance dashboards.
• Experience interpreting and reporting quality information.
• Experience training staff or supporting provider/care team education related to quality initiatives.
• Proficiency with Electronic Medical Record (EMR) software, payer portals, vendor platforms, and cloud-based applications.

Responsibilities

• Perform scheduled diabetic eye exams (retinal screenings) for members at provider practices and patient homes.
• Support broader quality improvement initiatives across delegated entities and contracted Accountable Care Organizations (ACOs) on non-appointment days.
• Conduct quality reporting, performance improvement, patient outreach, quality gap closure, and data abstraction activities.
• Serve as a quality improvement resource for internal teams, customers, providers, payers, and care teams.
• Identify quality gaps, support patient engagement, collect and validate quality data, and assist with payer-specific and ACO reporting requirements.
• Travel daily to provider practices and patient homes for scheduled eye exam appointments.
• Complete company-provided training on retinal imaging equipment and eye exam procedures.
• Conduct proactive patient outreach to identify and address quality gaps.
• Educate patients on preventive care measures, assist with scheduling necessary screenings or appointments, and support adherence to treatment plans.
• Manage a daily eye exam appointment schedule, confirm appointments, and coordinate travel logistics.
• Support ACO quality reporting and performance improvement activities.
• Collect, review, and abstract quality data using multiple data sources.
• Manage daily work using multiple systems and applications.
• Prioritize daily work to meet quality reporting deadlines.
• Communicate quality performance trends, barriers, and improvement strategies.
• Follow established policies, procedures, and workflows.
• Collaborate with customers, payers, providers, care teams, and internal departments.
• Participate in departmental, payer-sponsored, and ACO-related trainings, webinars, and support calls.
• Build and maintain strong working relationships with co-workers, customers, providers, payers, and care teams.
• Complete quality improvement department training, orientation, and shadowing.
• Support customer meeting preparation and potentially take lead or co-lead responsibility for quality improvement portions of customer meetings.
• Perform other duties as assigned to support quality improvement, reporting, patient outreach, and customer success.

Benefits

• Comprehensive Medical, Dental, and Vision plans
• 401(k) plan with a 3% employer match to a 6% contribution
• Life and Disability insurance
• Voluntary Life options
• Employee Assistance Program (EAP)
• Paid time off plans
• Paid parental leave
• Resources dedicated to learning and development