Specialist, Quality Interventions/QI Compliance (Remote in South TX)
About the position
- Responsibilities
- Oversee and implement healthcare quality improvement initiatives and education programs.
- Conduct data collection, reporting, and monitoring for key performance measurement activities.
- Direct and implement NCQA accreditation surveys and federal/state QI compliance activities.
- Initiate and manage provider, member, and community interventions to remove barriers to care.
- Prepare for Quality Improvement Compliance surveys and other required quality activities.
- Monitor and ensure timely and accurate completion of key quality activities.
- Write narrative reports interpreting regulatory specifications and documenting findings.
- Create and manage documentation to maintain critical quality improvement functions.
- Lead quality improvement activities and discussions with other departments.
- Evaluate project/program activities to identify opportunities for improvement.
- Requirements
- Bachelor's Degree or equivalent combination of education and work experience.
- Minimum 3 years' experience in healthcare with at least 1 year in health plan quality improvement or managed care.
- Demonstrated solid business writing experience.
- Operational knowledge and experience with Microsoft Excel and Visio.
- Nice-to-haves
- 1 year of experience in Medicare and Medicaid.
- Certified Professional in Health Quality (CPHQ) certification.
- Nursing License (RN may be preferred for specific roles).
- Certified HEDIS Compliance Auditor (CHCA) certification.
- Benefits
- Health insurance
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