Job Summary

The Quality Improvement (QI) Specialist supports the design, implementation, and evaluation of quality initiatives that enhance member outcomes, strengthen provider performance, and ensure compliance with regulatory requirements. This role is critical in advancing health plan performance across HEDIS, Medicare Stars, CAHPS, and Colorado Medicaid quality programs, while supporting NCQA accreditation and other compliance activities. The QI Specialist collaborates with cross-functional teams and external stakeholders to drive measurable improvements in clinical care, operational processes, and member experience.

Essential Functions:

Colorado Medicaid Quality Programs: Ensure compliance with HCPF quality requirements, including performance improvement projects (PIPs), External Quality Review Organization (EQRO) reporting, and population health initiatives. (20%)

NCQA & Compliance: Support National Committee for...