Position title
Clinical Quality Improvement Specialist

We're seeking a team member with clinical knowledge, Quality Improvement, and Compliance experience for a full time remote position.

  • Participate in annual compliance reviews including but not limited to the development of quality assessment tools, scheduling, pre-assessment policy and procedure review, onsite review activities and report preparation.
  • Reference and interpret Centers for Medicare & Medicaid Services (CMS) guidelines and regulations.
  • May serve as Team Lead for a specified task area and needs to demonstrate an understanding of the clinical aspects and evidence for the measures and clinical best practices for that task.
  • Assist in the overall assessment, planning, development, implementation, and evaluation of specific projects and quality improvement activities as necessary to fulfill contract deliverables.
  • Identify, present, and discuss contract progress and issues relating to project and assist in the implementation of solutions.
  • Coordinate, lead and/or participate in on-site healthcare provider review visits.
  • Coordinate, lead and/or participate in remote, desk reviews of healthcare provider care services, plans and progress with said quality improvement plans.
  • Assist in generating reports of project activities, outcomes as assigned or directed.
  • Establish and maintain effective relationships with healthcare providers and related groups.
  • Coordinate and participate in organizational and customer meetings.
  • Ability to provide technical assistance both onsite and virtually to healthcare providers and stakeholders.
  • Coordinates and conducts quality studies including medical record review.
  • Perform other duties as assigned.
  • Knowledge of the healthcare system/environment.
  • Basic computer skills (MS Word, Excel).
  • Familiarity with medical terminology.
  • Continuous Quality Improvement Training.
  • Knowledge of Quality Improvement and Assessment best practice
  • Willingness to travel approximately 35 percent.
  • Knowledge of the standards, tools, and data from the National Committee for Quality Assurance (NCQA) including Healthcare Effectiveness Data and Information Set (HEDIS), Quality Compass (QC), and Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
  • Excellent written and verbal communication skills.
  • Educational presentation skills.
  • Strong team leadership and project management skills.
  • Ability to work on multiple projects simultaneously and ability to effectively deal with changes to project requirements.
  • Ability to work in a team environment while possessing strong self-directed skills.
  • Attention to detail including excellent planning and organizational skills.
  • Strong customer service orientation, for both internal and external customers.
  • Takes the initiative to remain current with relevant clinical topics and Medicaid managed care performance improvement issues.
Employment Type
Job Location
Remote work possible
Base Salary
$95,000 Per year
  • 401(k)
  • Dental insurance
  • Flexible schedule
  • Health insurance
  • Life insurance
  • Paid time off
  • Referral program
  • Vision insurance
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