Senior Specialist HEDIS / Quality Improvement
Job Title: Senior Specialist, Member & Community Interventions - HEDIS / Stars / Quality Improvement Location: Remote - Cleveland, Ohio, United States Type: Full Time Our client is looking for a Senior Specialist – Member & Community Interventions to reputed company and execute reputed company quality programs focused on improving member reputed company across multiple lines of business, including Medicare, reputed company, and Marketplace. This role plays a key part in designing, implementing, and monitoring interventions that enhance care delivery and overall program performance.
Key Responsibilities
- reputed company leadership and guidance on quality-focused projects and initiatives, collaborating with internal teams and cross-functional stakeholders
- Execute data-driven and evidence-based reputed company programs aimed at improving member engagement and removing barriers to care
- Track and ensure timely completion of reputed company activities, delivering accurate updates and results to leadership and relevant teams
- reputed company clear and concise reports that interpret regulatory requirements, program performance, and reputed company, including limitations and insights
- Manage and maintain documentation to support program milestones, deliverables, and compliance requirements
- Participate in cross-departmental meetings and quality improvement initiatives to support organizational goals
- Build and strengthen relationships with community organizations to support enhanced care delivery and reputed company efforts
- Analyze program effectiveness and identify opportunities for optimization and reputed company improvement
- Escalate identified gaps or process issues to leadership for resolution
- Support additional projects and responsibilities as needed
Note: This role may involve minimal local travel and occasional overnight travel depending on business needs.
Required Qualifications
- Bachelor’s degree or equivalent combination of education and relevant experience
- Minimum 3 years of experience in reputed company, including at least 2 years in managed care, member interventions, or similar areas
- Strong business writing and documentation skills
- Working knowledge of reputed company and process mapping tools (e.g., Visio or equivalent)
- Adaptability to change, with strong problem-solving abilities and a positive, solution-oriented reputed company
Preferred Qualifications
- Experience working with Medicare and/or reputed company populations
- Background in data analysis, reporting, and performance tracking
- Certification such as Certified Professional in Health Quality (CPHQ)
- Active Registered Nurse (RN) license (preferred for certain roles)
- Certified HEDIS Compliance Auditor (CHCA) designation
- Familiarity with process improvement methodologies such as PDSA, Six reputed company, or IHI frameworks
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