Quality Performance Specialist

Job Summary As part of the Quality Management team, the Quality Performance Specialist is responsible for coordinating, implementing, and monitoring Quality Improvement (QI) program objectives. This role supports performance improvement initiatives for clinical and service activities, integrates the Quality Improvement Plan across departments, and facilitates HEDIS, CAHPS, and NCQA accreditation activities. The Quality Performance Specialist supports the implementation of quality programs designed to meet or exceed applicable state, federal, regulatory, and NCQA standards and collaborates across functional areas to achieve organizational quality, clinical, and service goals.

Key Responsibilities

• Executes organizational Quality Improvement (QI) initiatives and ongoing quality improvement processes to support compliance with applicable state, federal, regulatory, and accreditation requirements.
• Supports the completion and analysis of annual HEDIS results and partners with departments to integrate findings into departmental goals and improvement strategies.
• Supports the development, implementation, and evaluation of the annual Quality Improvement (QI) Work Plan and Program Description.
• Facilitates Quality Improvement initiatives throughout the organization.
• Identifies, resolves, and/or escalates quality improvement concerns that may place the health plan at risk of not achieving annual performance goals.
• Collaborates with Provider Services and Member Services to analyze annual satisfaction survey results and integrate findings into departmental goals and improvement initiatives.
• Participates in the development, implementation, and maintenance of Quality Improvement policies and procedures.
• Serves as a Quality Improvement resource to departments working to achieve quality and performance goals.
• Partners effectively with cross-functional teams to support organizational and departmental quality, service, and performance objectives.
• Participates in Quality Improvement committees focused on achieving measurable outcomes.
• Completes committee documentation in accordance with applicable regulatory and accreditation requirements.
• Utilizes performance improvement methodologies and tools to identify barriers, evaluate interventions, and support measurable improvement.

Education and Experience

• Associate's degree or equivalent combination of education and relevant work experience required.
• Minimum of 3 years of experience in clinical quality improvement, service quality improvement, healthcare delivery, or a related area preferred.
• HEDIS experience preferred.
• Managed care healthcare experience preferred.
• Experience with performance improvement and quality improvement methodologies preferred.
• Experience utilizing performance and Quality Improvement tools and methodologies, including:
• Plan-Do-Study-Act (PDSA)
• Barrier Analysis
• Key Driver Diagrams

Skills and Qualifications

• Strong knowledge of Quality Improvement (QI) principles, processes, and performance improvement methodologies.
• Knowledge of HEDIS, CAHPS, NCQA, regulatory requirements, and healthcare quality standards preferred.
• Excellent organizational, analytical, and interpersonal skills.
• Excellent written and verbal communication skills.
• Ability to collaborate effectively with individuals and teams across all levels of the organization.
• Ability to design, develop, implement, and evaluate projects addressing quality, financial, clinical, and service improvement opportunities.
• Strong analytical and problem-solving skills with the ability to identify performance gaps and support corrective or improvement strategies.
• Proficiency with PCs and applications in a Windows-based environment.