Senior Quality Improvement Specialist

About the role

The Senior Quality Improvement Specialist leads and coordinates regulatory, accreditation, and clinical quality initiatives across multiple large‑scale programs. This role partners with national, regional and multi‑plan teams to develop and monitor compliance programs that enhance health‑care delivery and member outcomes.

Key responsibilities

• Lead complex quality improvement projects impacting clinical care and service effectiveness.
• Ensure all initiatives comply with accreditation, state and federal requirements.
• Assess program performance, refine activities, and report outcomes to senior leadership.
• Oversee vendor relationships and manage external collaborations.
• Develop targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, and provider satisfaction metrics.
• Create project communications such as member/physician mailings, IVR scripts, emails, and business plans.
• Maintain and update annual quality improvement documentation, policies, and audit reports.
• Present internal progress reports and facilitate cross‑functional committee work.

Required profile

• Extensive experience in HEDIS operations and clinical medical record review.
• Proven ability to manage multiple large‑scale initiatives simultaneously.
• Strong knowledge of accreditation standards and regulatory compliance.
• Excellent analytical and reporting skills with a focus on outcome improvement.
• Effective communication and stakeholder engagement abilities.

Required skills

• HEDIS operations
• Clinical medical record review
• Regulatory and accreditation compliance
• Vendor oversight and management
• Project communication development