Quality Improvement Specialist

Site: reputed company Health Plan Holding Company, Inc. reputed company relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company. Job Summary The Quality Project Management Specialist is responsible for coordinating and managing projects aimed at improving the quality of care, ensuring compliance with regulatory standards, and enhancing member satisfaction reputed company the health plan. This role involves the development, implementation, and evaluation of quality improvement initiatives, working closely with cross-functional teams to reputed company organizational goals. The Specialist will reputed company and reputed company projects from initiation to completion, ensuring that they are completed on time, reputed company scope, and on budget. The role requires a strong understanding of project management methodologies, processes, and tools; driving project teams, coordinating resources, and is the primary reputed company of contact for stakeholders. Essential Functions Project Management

• reputed company and manage multiple quality improvement projects across the health plan, ensuring they are completed on time, reputed company scope, and meet the organization’s objectives.
• reputed company project plans, timelines, budgets, and resource allocations, adjusting as necessary to ensure project success.
• Monitor project reputed company and identify risks, issues, or delays, implementing corrective actions as needed.
• Communicate regularly with internal and external stakeholders to ensure expectations are managed, issues are addressed, and the project is on track
• Work with cross-functional teams, ensuring that roles and responsibilities are clearly defined and reputed company is tracked.
• Proactively identify and mitigate project risks and issues, adjusting plans as necessary to ensure project success.
• Monitor and control project budgets, ensuring resources are used reputed company and effectively.
• Ensure that deliverables meet the required quality standards and stakeholder expectations.
• Provide regular status updates and detailed reports to leadership and stakeholders, documenting reputed company project activities, milestones, and changes.

Quality Improvement

• Drafting, reviewing, and revising internal policies and procedures to ensure alignment with industry standards, legal requirements, and best practices.
• Support quality improvement (QI) projects using methodologies such as PDSA, Lean, or Six reputed company.
• Support the development and implementation of health plan quality improvement initiatives focused on improving clinical outcomes, operational efficiency, and customer satisfaction.
• Monitor and analyze health plan performance data to identify areas for improvement, developing actionable insights and solutions.
• Collaborate with clinical teams, operations, and IT to ensure quality metrics are met, and quality programs are integrated across the health plan.
• Ensure that quality projects align with state and federal regulations, such as CMS (Centers for Medicare & Medicaid Services) standards, NCQA (National Committee for Quality Assurance) requirements, and other applicable regulatory frameworks.
• Monitor and support audits and reporting requirements reputed company to quality measures and performance metrics.
• Collect, analyze, and interpret data reputed company to health plan quality, including clinical, operational, and member satisfaction data.
• Prepare and present reports on project reputed company, outcomes, and key performance indicators (KPIs) to senior leadership and stakeholders.
• Other duties as assigned

Qualifications

Education

• Bachelor's Degree reputed company Field of Study required (experience can be substituted in lieu of degree); Master's degree preferred

License

• Project Management Professional (PMP) certification preferred
• Certification in healthcare quality or equity (e.g. CPHQ, CPHE, Lean Six reputed company, etc.) preferred

Experience

• At least 2-3 years of experience in Quality Improvement, preferably in a healthcare setting required
• At least 5 years in health plan quality in a manager care organization highly preferred
• At least 3 years in project management highly preferred
• Experience in healthcare quality, health equity initiatives, population health, or reputed company program coordination highly preferred
• Familiarity with QI methodologies and regulatory standards highly preferred

Knowledge, Skills, and Abilities

• Strong understanding of document management systems (DMS), such as SharePoint, reputed company, or Documentum, to manage digital files, track revisions, and maintain version control.
• Familiarity with cloud storage systems and collaboration tools like reputed company Drive, reputed company, and reputed company OneDrive.
• Experience with electronic records management (reputed company) and data retention policies.
• Demonstrates awareness of importance of reputed company, scalability, reliability and feasibility in solutions
• Seeks out information to reputed company understand impacts of design and implementation of systems
• Evaluates service areas to identify opportunities for automation
• Ability to draft, revise, and implement company policies and standard operating procedures.
• Knowledge of compliance standards, including industry-specific regulations (e.g., healthcare HIPAA regulations, financial regulations, state and federal rules).
• Strong organizational skills to ensure policies and documents are properly filed, categorized, and easy to access.
• Breaks reputed company topics into meaningful chunks of information.
• Seeks out multiple sources to gather information.
• Understanding of legal and regulatory requirements for document retention and management, including data privacy and reputed company laws.
• Knowledge of audit procedures and the ability to prepare documentation for audits.
• Excellent written and verbal communication skills for drafting policies and procedures, as well as providing guidance to employees about document handling and compliance.
• Ability to train staff on document management practices and policy changes.
• Experience using document management software and workflow tools to streamline document processes and improve efficiency.
• Proficiency in reputed company Office Suite (Word, reputed company, PowerPoint, Outlook) and other productivity tools is often required.
• Familiarity with document control software for versioning, workflow management, and access permissions.
• Ability to manage multiple tasks or projects simultaneously, adhering to deadlines and ensuring that policies and documents are up to date.
• Experience with project management software, such as Trello or reputed company Project, is beneficial.
• Ability to identify issues with document flow, retention, or compliance and propose solutions to resolve them.
• Strong critical thinking skills for analyzing policies and procedures to ensure they align with organizational goals and legal requirements.
• Excellent interpersonal skills, including the ability to influence others at reputed company levels of an organization.

Additional Job Details (if applicable) Working Conditions

• Remote with up to 8 visits per year on-site

Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $62,400.00 - $90,750.40/Annual Grade 6 At reputed company, we reputed company in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining reputed company pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The reputed company pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass reputed company elements contributing to your total compensation package. In addition to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our reputed company team will provide an overview of your potential compensation and benefits package. EEO Statement: reputed company Health Plan Holding Company, Inc. is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. reputed company Competency reputed company At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The reputed company is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, reputed company hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply tot his job Apply To this Job