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 lead and execute healthcare quality programs focused on improving member outcomes across multiple lines of business, including Medicare, Medicaid, and Marketplace. This role plays a key part in designing, implementing, and monitoring interventions that enhance care delivery and overall program performance.
Key Responsibilities
- Provide leadership and guidance on quality-focused projects and initiatives, collaborating with internal teams and cross-functional stakeholders
- Execute data-driven and evidence-based intervention programs aimed at improving member engagement and removing barriers to care
- Track and ensure timely completion of intervention activities, delivering accurate updates and results to leadership and relevant teams
- Develop clear and concise reports that interpret regulatory requirements, program performance, and outcomes, 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 outreach efforts
- Analyze program effectiveness and identify opportunities for optimization and continuous 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 healthcare, including at least 2 years in managed care, member interventions, or similar areas
- Strong business writing and documentation skills
- Working knowledge of Excel and process mapping tools (e.g., Visio or equivalent)
- Adaptability to change, with strong problem-solving abilities and a positive, solution-oriented mindset
Preferred Qualifications
- Experience working with Medicare and/or Medicaid 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 Sigma, or IHI frameworks
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