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HM
Quality Improvement Specialist
HMSAUnited Statesfull_timeVerifiedPosted 5 May 2025
About the role
- Proficient in all federal, state and commercial Quality Improvement standards (NCQA, CMS, MQD); coordinates with internal departments and delegates to ensure that standards are met and that appropriate program deliverables (e.g., descriptions, policies/procedures, reports, etc.) are developed, implemented, and reported.
- Serve as Chair and/or facilitator of designated quality committees, develop monthly agenda's and facilitate meaningful discussion to monitor the quality of care and services that members receive. Ensure that various quality indicators are discussed and properly analyzed and that recommendations resulting from indicator monitoring are reported through the Quality Improvement Committee Structure.
- Schedules and conducts office site, facility, medical record and other clinical reviews as required in accordance with established standards.
- Serve as Project Coordinator as needed for Quality Improvement Activities.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
- Responsible for the auditing and reporting of the delegated standards for the annual site visit to all delegated entities
- Other duties as assigned related to ensuring that various Quality Improvement Standards are met, including coordination of HEDIS and other mandated audits
- Bachelor's degree and two years of related work experience working; or equivalent combination of education and related work experience.
- Effective communication skills
- Basic working knowledge of Microsoft Office applications. Including but not limited to Word, PowerPoint and Outlook.
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