Ambulatory Quality and Patient Safety Specialist

Job Description

The Ambulatory Quality and Patient Safety Specialist for Ambulatory Care is responsible for the execution, coordination, and continuous advancement of ambulatory quality, patient safety, performance improvement, and managed care quality initiatives across all ambulatory services.

This role functions within Ambulatory Operations and Ambulatory Leadership, working in close partnership with clinical leadership, nursing, operations, population health, patient access, finance, and managed care teams to ensure ambulatory services achieve optimal clinical outcomes, regulatory compliance, and value-based financial performance.

The Ambulatory Quality and Patient Safety Specialist plays a critical role in translating organizational quality strategy into operational practice, with a strong emphasis on managed care quality performance, including HEDIS, Medicaid STAR ratings, Medicare quality measures, and payer-specific incentive programs.

Responsibilities

• Execute ambulatory quality priorities aligned with enterprise strategy, regulatory requirements, and value-based care programs.
• Cook up and monitor performance improvement (PI) projects, ensuring defined metrics, timelines, documentation, and measurable outcomes.
• Support interdisciplinary quality committees, workgroups, and operational forums through data analysis, reporting, and follow-up.
• Serve as a key operational partner in improving ambulatory quality performance tied to managed care reimbursement and incentive revenue.
• Collaborate with Patient Access and Navigation Hub, Managed Care, IPA, Finance, and Population Health teams to optimize performance under payer quality programs, including:
• Healthfirst
• Fidelis Care
• MetroPlus Health Plan
• Emblem Health
• Stellar Health
• Affinity / Molina
• UnitedHealthcare Community Plan
• Aetna Better Health
• Medicare Advantage and other contracted plans
• Track, analyze, and trend HEDIS measures, Medicaid STAR ratings, Medicare quality metrics, and payer-specific performance indicators.
• Identify gaps in performance that impact quality scores, risk adjustment, and incentive payments.
• Support the development and execution of targeted interventions to improve care gap closure, documentation accuracy, preventive care compliance, and chronic disease management.
• Participate in payer audits, data validation processes, and quality-related inquiries to ensure accuracy, integrity, and maximized revenue capture.
• Track and analyze data generated from internal and external sources, including but not limited to:
• Patient care evaluation studies
• Variance analysis
• Performance improvement studies
• Financial and revenue performance reports
• Departmental reviews and audits
• Committee minutes and action plans
• External quality reporting systems and payer dashboards
• Develop, maintain, and interpret ambulatory quality dashboards and scorecards.
• Identify trends, risks, and opportunities related to quality outcomes, patient safety, access, and financial performance.
• Ensure accurate, timely, and consistent ambulatory quality reporting to leadership and external stakeholders.
• Support continuous regulatory readiness for ambulatory services, including Joint Commission, NYSDOH, CMS, PCMH, and payer audits.
• Conduct ambulatory audits, tracers, and assessments to identify gaps in compliance, documentation, workflows, and clinical practice.
• Participate in the development, execution, and monitoring of Corrective Action Plans related to quality, safety, or regulatory findings.
• Serve as a technical resource for ambulatory regulatory standards and quality reporting requirements.
• Promote a culture of patient safety, transparency, and Person Centered Care culture across all ambulatory practices.
• Partner with nursing and clinical leadership to ensure standardized, evidence-based ambulatory care delivery.
• Reinforce safety education, reporting expectations, and accountability frameworks.
• Collaborate with Ambulatory Operations, Nursing Leadership, Medical Directors, Practice Managers, Patient Access and Navigation Hub, and Population Health teams to integrate quality into daily operations.
• Absorb and execute the Ambulatory Culture of Safety Program, including administration of the AHRQ SOPS survey, development and monitoring of action plans, leadership reporting, and integration of patient safety and just culture principles into daily ambulatory operations.

Qualifications

• Required: Bachelor’s degree in Healthcare Administration, Nursing, Public Health, Business Administration, or a related field (or equivalent experience).
• Minimum of 3–5 years of experience in healthcare quality, performance improvement, managed care quality, or population health.
• Experience working in ambulatory care or outpatient clinical environments.
• Demonstrated experience with HEDIS measures, Medicaid STAR ratings, Medicare quality programs, and payer quality initiatives.
• Strong working knowledge of healthcare data analytics, quality reporting, and performance improvement methodologies.
• Preferred: Master’s degree in Healthcare Administration, Public Health, Nursing, or a related field.
• Healthcare quality manager certification (CPHQ, CQM, or equivalent).
• Clinical experience as a Physician Assistant (PA) or similar advanced clinical role.
• Experience in safety-net health systems, unionized environments, or Article 28 clinics.
• Experience working directly with Managed Medicaid and Medicare Advantage plans.
• Leverage, Six Sigma, or formal quality improvement certification or training.

Skills & Competencies

• Advanced understanding of ambulatory quality measurement, managed care quality programs, and value-based reimbursement models.
• Strong analytical skills with the ability to interpret clinical, operational, and financial data.
• Experience working with EMRs, payer portals, quality reporting systems, and performance dashboards.
• Ability to manage complex datasets and translate findings into actionable improvement strategies.
• Strong project management and organizational skills.
• Excellent written and verbal communication skills, including presentation of technical quality data.
• Ability to work effectively in a highly matrixed environment across clinical, operational, and financial teams.
• Collaborative, disciplined, and outcomes-focused leadership style.
• High level of integrity, accountability, and commitment to mission-driven healthcare.