Quality Specialist (Hybrid)

About the role

This position leverages population health frameworks like NCQA Accreditation, HEDIS, and CMS to deliver culturally sensitive health promotion to members. The goal is to enhance access to preventive care and improve health outcomes through targeted interventions.

Responsibilities

• Conduct outreach to members and providers to address care gaps, documenting efforts for collaborative improvement.
• Analyze quality reports and claims data to monitor member compliance with various quality measures.
• Collaborate with in-home and community-based providers to identify non-compliant members and facilitate referrals for quality improvement campaigns.
• Maintain access to provider-reported outcomes and share this information with relevant stakeholders.
• Stay updated on population health, accreditation, and quality improvement methodologies.

Qualifications

• Education: Bachelor's degree in Population Health, Public Health, Healthcare Administration, Business Administration, Health Policy, Economics, Statistics, Mathematics, Data Science, or related field, or equivalent experience.
• Experience: 3+ years of professional experience in a business environment, preferably in public health, health insurance, or management consulting.
• Preferred Qualifications: Previous experience in member/provider engagement, certification in quality/process improvement methods, direct experience with accreditation, HEDIS, CAHPS, and healthcare-related environments.

Skills and Abilities

• Engage health consumers/providers in outcomes-driven assessments and improvements.
• Expertise in qualitative and quantitative data analysis and presentation.
• End-to-end experience in designing, developing, and implementing strategies to improve population health.
• Familiarity with Microsoft tools including Excel, Word, PowerPoint, and Outlook.
• Knowledge of healthcare claims, surveys, clinical, and health data.
• Ability to meet deadlines and handle multiple customer service demands.
• Effective communication and positive customer service skills.

Pay

$48,168 - $95,667 annually, depending on experience and qualifications.

Schedule

The role requires a hybrid work model, with a portion of the week spent working from home and another portion at a CareFirst location based on business needs.