QI Specialist II

Job Title: QI Specialist (Medicare Stars)

Job Location: Remote

Shift: Mon-Fri 8am -5 pm PST

Job Duration: 6 months (Possibility of extension)

QI Specialist (Medicare Stars)

Quality Specialist (Medicare Stars) is responsible for implementing strategies to improve Medicare Star Ratings, drive clinical quality indicators (HEDIS Star metrics), CAHPS, and HOS efforts Key duties include analyzing performance data and executing on planned activities and interventions aimed at improving Medicare Star Ratings.

Job duties

• Monitor and analyze quality performance metrics, identify trends and gaps, and generate reports and dashboards to visualize performance for various stakeholders.
• Collaborate with the Quality Improvement department staff in the development of quality improvement studies, initiatives, and projects to improve the health care of members.
• Supports health plan provider engagement strategy to achieve positive quality outcomes through effective provider engagement activities.
• Effectively communicate performance updates, insights, and recommendations to internal stakeholders
• Proven ability to plan, organize, and manage multiple projects and initiatives simultaneously.
• Participates in the development of materials as needed for member and provider quality initiatives such as HEDIS, improvement projects, and studies.
• Supports various HEDIS activities as needed, including medical record retrieval.
• Maintains the highest level of compliance.
• Excellent verbal and written communication skills to influence stakeholders and educate various audiences.
• Experience in Medicare Stars program oversight, quality improvement principles, and project/program management.
• Ability to work independently, adapt to changing priorities, and thrive in a fast-paced, dynamic environment.

Required Skills:

• Proficiency with PC-based systems especially Excel
• Excellent verbal and written communication skills
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.
• Working knowledge of Quality/HEDIS metrics.
• Demonstrates data analytic skills. 

Required Experience

• 2-4 years experience in Quality Improvement and in managed care or healthcare industry.
• Experience with qualitative or quantitative projects/analysis.
• Operational knowledge and experience with PowerPoint, Excel, Visio