Market Quality Improvement Specialist III

📋 Description

• • Conducts business process and gap analysis to identify opportunities for HEDIS data and process improvement in new or existing projects with a focus on measurable outcomes
• • Leads improvement work teams by collaborating with management to select team members, coordinate meetings, and manage project execution using principles of process excellence
• • Supports documentation of Quality Improvement Projects (QIPs) and Performance Improvement Projects (PIPs) and other quality-related activities
• • Trains and educates department staff on improvement tools, methodologies, and best practices to ensure consistent application across teams
• • Analyzes work processes using Lean, Six Sigma, and Model for Improvement (PDSA) methodologies to pinpoint inefficiencies and design actionable solutions
• • Prepares and delivers presentations to providers independently, building relationships and addressing inquiries to enhance compliance and performance
• • Works with leadership to establish and implement effective measurement systems and data collection methods for quality initiatives
• • Reviews and measures progress of improvement initiatives with management and work teams, taking corrective action as needed
• • Researches and applies industry best practices from outside healthcare to innovate internal quality improvement efforts
• • Develops, evaluates, and implements survey tools to gather feedback and inform improvement priorities
• • Analyzes survey data to provide evidence-based recommendations for program and operational enhancements
• • Coordinates participation in quality improvement committee meetings by developing agendas, preparing minutes, delivering presentations, and tracking action items
• • Communicates clearly and professionally with upper management, peers, department staff, external agencies, and vendors to ensure timely information exchange and issue resolution
• • Assists in tracking, compiling, and reporting program and project metrics to support decision-making and regulatory reporting
• • Researches, gathers, and analyzes data to uncover trends and opportunities for quality improvement
• • Collaborates with Maternal Child and Health Outcomes Management and Vendor Management teams to monitor vendor and community partner performance
• • Monitors monthly, quarterly, and annual vendor reporting to ensure timely submission and data accuracy
• • Participates in cross-functional workgroups and applicable committees to align quality initiatives with organizational goals
• • Prepares reports, briefing materials, and other deliverables for programs and projects as requested
• • Applies knowledge of healthcare regulations, accreditation standards, Medicaid, and Medicare requirements to guide quality improvement activities
• • Maintains proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) to produce accurate documentation, analyses, and presentations
• • Demonstrates strong facilitation, teaching, and interpersonal skills to engage teams positively and drive sustainable change
• • Exhibits attention to detail, critical thinking, and problem-solving abilities in all quality improvement activities
• • Works independently and collaboratively within a team environment to meet goals and deliver high-quality outcomes
• • Adheres to federal and state healthcare regulations and accreditation standards in all assigned responsibilities
• • Performs additional job-related duties as requested by management