Quality Improvement Specialist

**Hybrid Work Environment - Must reside in Oahu**

Ensure that all internal/external Quality Improvement standards and regulations are met, and that policies and procedures are written, implemented and updated as needed to meet these standards. Maintain the highest level of quality accreditation status for all HMSA lines of business.

• Proficient in all federal, state and commercial Quality Improvement standards (NCQA, CMS, MQD); coordinates with internal departments and delegates to ensure that standards are met and that appropriate program deliverables (e.g., descriptions, policies/procedures, reports, etc.) are developed, implemented, and reported.

• Serve as Chair and/or facilitator of designated quality committees, develop monthly agenda's and facilitate meaningful discussion to monitor the quality of care and services that members receive. Ensure that various quality indicators are discussed and properly analyzed and that recommendations resulting from indicator monitoring are reported through the Quality Improvement Committee Structure.

• Schedules and conducts office site, facility, medical record and other clinical reviews as required in accordance with established standards.

• Serve as Project Coordinator as needed for Quality Improvement Activities.

• Performs all other miscellaneous responsibilities and duties as assigned or directed.
  • Responsible for the auditing and reporting of the delegated standards for the annual site visit to all delegated entities
  • Other duties as assigned related to ensuring that various Quality Improvement Standards are met, including coordination of HEDIS and other mandated audits