Quality Performance Specialist

Role Overview

The Quality Performance Specialist is responsible for coordinating, monitoring, and supporting Quality Improvement (QI) program objectives and performance improvement initiatives. This role drives organizational quality outcomes through the implementation of quality programs, performance monitoring, regulatory compliance activities, and accreditation support. The specialist partners across departments to integrate quality improvement strategies, facilitate Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and National Committee for Quality Assurance (NCQA) activities, and ensure compliance with state, federal, and accreditation standards.

Key Responsibilities

• Support and execute organizational Quality Improvement (QI) initiatives to ensure compliance with state, federal, regulatory, and accreditation requirements.
• Analyze annual HEDIS results and collaborate with cross-functional teams to incorporate findings into departmental goals and performance strategies.
• Facilitate the development, implementation, and evaluation of the annual QI Work Plan and Program Description.
• Identify, address, and escalate quality-related risks that may impact achievement of organizational quality goals.
• Partner with Provider Services and Member Services teams to analyze member and provider satisfaction survey results and integrate findings into improvement plans.
• Develop, implement, and maintain Quality Improvement policies, procedures, and best practices.
• Serve as a subject matter resource for departments working toward quality improvement objectives.
• Collaborate with stakeholders at all levels of the organization to support quality, service, and operational excellence initiatives.
• Participate in Quality Improvement committees and ensure documentation meets regulatory and accreditation standards.
• Support continuous performance improvement activities through data analysis, reporting, and process optimization.

Required Education & Experience

• Associate's degree or equivalent combination of education and relevant work experience required.
• Bachelor's degree preferred.
• Minimum of three (3) years of experience in Quality Improvement, Healthcare Quality, Clinical Operations, Population Health, Managed Care, or Healthcare Service Delivery preferred.
• Experience working in a high-volume, performance-driven healthcare environment while maintaining regulatory compliance.
• Knowledge of critical incident reporting requirements and Office of Long-Term Living (OLTL) regulations.
• Experience using Enterprise Incident Management systems.
• Managed Care Organization (MCO) experience preferred.

Required Skills & Competencies

• Strong knowledge of healthcare quality improvement methodologies and performance management practices.
• Experience supporting HEDIS, CAHPS, NCQA accreditation, quality audits, and regulatory compliance initiatives.
• Excellent organizational, project management, and time management skills.
• Strong verbal and written communication skills with the ability to engage stakeholders across multiple levels of the organization.
• Demonstrated ability to design, develop, implement, and evaluate projects focused on quality, service, operational, and financial improvements.
• Advanced analytical and problem-solving skills, including data interpretation and root-cause analysis.
• Advanced Microsoft Office proficiency.
• Ability to accurately enter, manage, and analyze data while maintaining data integrity.
• Strong collaboration and relationship-building skills in cross-functional healthcare environments.

Our Comprehensive Benefits Package

• Flexible work solutions including remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events.
• Health insurance coverage for you and your dependents starting Day 1.
• 401(k) retirement savings plan.
• Tuition reimbursement.

About AmeriHealth Caritas

AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.