Quality Improvement Specialist - 26-96

We’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions, and anticipates the needs of our members. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and one of the “Healthiest Places to Work in the Bay Area.”

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. We welcome all aspects of your identity—race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allow us to leverage differences and capitalize on similarities to better serve our communities.

About the role

The Quality Improvement Specialist implements quality-of-care initiatives to support HEDIS/NCQA/IHA/CMS Stars quality measure performance and related activities. This role collaborates closely with physician practices, patients, and cross-functional departments to improve performance on clinical quality measures.

Responsibilities

• Support the Clinical Quality team with implementing quality improvement initiatives, analyzing clinical data, and compiling information into spreadsheets and databases.
• Develop clinical quality tip sheets, toolkits, and resources for distribution along with care gap reports to physician practices.
• Abstract clinical information from electronic health records and input data accurately into the patient registry (Cozeva) to improve clinical quality measure performance.
• Determine if medical chart documentation meets audit requirements of HEDIS/NCQA clinical measure specifications and guidelines.
• Engage with physician practices to educate on clinical quality measures, train on the patient registry (Cozeva), and conduct tailored campaigns to close care gaps.
• Directly outreach to patients to assist in closing care gaps; coordinate care with physician offices, pharmacies, and other providers.
• Ensure project tasks and deliverables are completed appropriately and on time; identify and communicate issues to management and stakeholders in a timely manner; proactively identify risks and work with stakeholders to mitigate them.

Requirements

• Bachelor’s degree with relevant experience in a healthcare setting OR minimum 3 years of relevant experience in a healthcare setting.
• Experience with HEDIS/NCQA clinical quality measures.
• Knowledge of electronic health records and ability to quickly learn new software.
• Advanced Microsoft Excel skills.
• Strong analytical, critical thinking, and problem-solving skills.
• Excellent oral and written communication skills.
• Demonstrated ability to exercise independent judgment and problem-solve under pressure of deadlines and resource constraints.
• Demonstrated ability to work on multiple projects and/or perform more than one function on a given project.

Pay

$97,000 - $127,000 annual.