Quality Improvement Specialist Sr

HEDIS Operations experience highly preferred Clinical Medical Record Review experience. Position Purpose: The Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical quality and/or service improvement programs. Functions as a leader for assigned health services initiatives handling multiple large-scale complex initiatives. Collaborates on national, regional and multi-plan initiatives. Develops programs in compliance with accreditation and regulatory requirements/ standards and monitors ongoing program performance to maintain compliance. Acts as a resource for training, policy and regulatory/accreditation interpretation. Leads and manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services provided to members. Ensures that clinical and service quality improvement programs and initiatives are compliant with applicable accreditation, state and federal requirements. Conducts an assessment of programs, initiatives and interventions to ensure goals and objectives were met and refine activities, as needed, to improve the effectiveness and improve outcomes. Conducts vendor oversight and management. Develops targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other identified performance measures. Develops and implements project-related communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas. Participates in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities. Develops internal reports to demonstrate progress on each initiative/project and presents to senior-level staff. Describes outreach initiatives, potential/experienced barriers and activities to resolve issues and improve outcomes. Leads and/or pa