Quality Improvement Specialist - Denver Health Medical Plan (Must Be A Colorado Resident)

We are recruiting for a motivated Quality Improvement Specialist - Denver Health Medical Plan (Must Be A Colorado Resident) to join our team!

We are here for life’s journey.
Where is your life journey taking you?

Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:

Humanity in action, Triumph in hardship, Transformation in health.

Department

Managed Care Administration

*Must Be A Colorado Resident*

Job Summary

The Quality Improvement (QI) Specialist supports the design, implementation, and evaluation of quality initiatives that enhance member outcomes, strengthen provider performance, and ensure compliance with regulatory requirements. This role is critical in advancing health plan performance across HEDIS, Medicare Stars, CAHPS, and Colorado Medicaid quality programs, while supporting NCQA accreditation and other compliance activities. The QI Specialist collaborates with cross-functional teams and external stakeholders to drive measurable improvements in clinical care, operational processes, and member experience.

Essential Functions:

• Colorado Medicaid Quality Programs: Ensure compliance with HCPF quality requirements, including performance improvement projects (PIPs), External Quality Review Organization (EQRO) reporting, and population health initiatives. (20%)
• NCQA & Compliance: Support National Committee for Quality Assurance (NCQA) accreditation readiness and regulatory audits by maintaining accurate documentation and work plans. Stay current on Centers for Medicare & Medicaid Services (CMS), NCQA, and Health Care Policy and Financing (HCPF) guidelines.
  (5%)
• Population Health & Outcomes: Partner with care management, pharmacy, and provider networks to design and implement quality interventions that improve outcomes and reduce disparities.
  (10%)
• Process Improvement: Apply quality improvement methodologies (e.g., PDSA, Lean, Six Sigma) to evaluate workflows, streamline processes, and enhance operational efficiency. (15%)
• Member & Provider Experience: Collect and analyze feedback (CAHPS, surveys, advisory groups) to inform strategies that improve access, coordination, and satisfaction. (10%)
• Data Analysis & Reporting: Develop dashboards, reports, and presentations for leadership, committees, and external stakeholders, ensuring accuracy and timeliness. (20%)
• Committee Participation: Facilitate or support quality committees, workgroups, and cross-departmental projects 15focused on clinical and operational improvement. (20%)
• (0%)

Education:

• Bachelor's Degree Public Health, Nursing, or related field.

Work Experience:

• 4–6 years’ experience in health plan quality improvement, with direct experience in HEDIS and Stars required

Licenses:

• CPHQ-Certified Professional Healthcare Quality - NAHQ - National Association for Healthcare Quality
• GREENBELT-Green Belt - SSGI - Six Sigma Global Institute

Knowledge, Skills and Abilities:

• Familiarity with Colorado Medicaid quality programs, HCPF requirements, and EQRO processes.
• Demonstrated knowledge of NCQA accreditation standards, CMS requirements, and managed care operations.
• Strong data analysis and reporting skills (Excel required; Tableau, SAS, or other tools preferred).
• Excellent communication and project management skills with ability to influence cross-functional teams.
• Strong Verbal and written skills

Shift

Days (United States of America)

Work Type

Regular

Salary

$78,900.00 - $122,300.00 / yr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program 

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

  <