Senior Clinical Quality Performance Specialist

Responsibilities

• Provide key data analysis and critical thinking for the development and assessment of quality improvement project interventions.
• Develop reports and analyses, and present findings to the Quality Committee for input and direction.
• Support HEDIS and Clinical Practice Guidelines.
• Support accreditation activities and clinical quality performance improvement initiatives.
• Perform ad-hoc analyses of underperforming processes by collaborating with Subject Matter Experts (SME) and internal stakeholders to define current processes and recommend improvements.
• Remove barriers to ensure the successful completion of strategic quality projects.
• Carry out analyses and provide summary reports to senior management.
• Act as a primary liaison to internal departments requiring collaboration and coordination.
• Support the development of new and existing staff by identifying learning and training opportunities.
• Serve as a mentor to new hires, ensuring consistency in information and training.

Qualifications

• Ace’s Degree or equivalent work experience required.
• Registered Nurse (RN) required.
• 5 years of experience in clinical or service quality improvement required.
• 5 years of experience in managed care required.
• Unrestricted Registered Nurse license in the plan’s state or any state in which the individual works.
• Experience working within a managed care plan organization.
• Intermediate or expert level user of Microsoft Excel/SAS.
• Experience managing National Committee of Quality Assurance (NCQA) accreditation surveys preferred.
• Knowledge and understanding of quality improvement functions within a Managed Care Organization (MCO) preferred.
• Prior experience with project facilitation and/or project management preferred.
• Proficient in Microsoft Excel or other data tools.
• Excellent written and verbal communication skills.
• Strong organizational, analytical, and interpersonal skills.
• Ability to work effectively across all levels of the organization.
• Ability to design, develop, and implement projects addressing financial, quality, and service improvements.