About this role
About the Role The QCI Specialist I is responsible for supporting quality improvement initiatives that drive performance across HEDIS, Medicare Stars, Medicaid, Commercial, and other quality programs. This role collaborates with provider practices, health plans, and internal stakeholders to improve quality outcomes, close care gaps, support practice transformation efforts, and enhance provider performance. The QCI Specialist I provides practice-level support for quality improvement programs, provider education activities, population health initiatives, quality reporting, and care gap closure strategies while serving as a trusted resource to providers and practice staff. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team Quality Performance & Program Management Support day-to-day execution of quality improvement programs, provider performance initiatives, and population health strategies. Monitor provider performance against HEDIS, Medicare Stars, Medicaid, Commercial, and other quality measures; analyze results and recommend improvement opportunities. Collaborate with providers and practice staff to implement care gap closure, outreach, education, and quality improvement interventions that support achievement of performance targets. Collect, validate, and submit medical record documentation and quality data to ensure accurate reporting, measurement, and compliance. Provider & Practice Engagement Partner with provider practices through onsite and virtual engagement to improve quality performance, operational effectiveness, and patient outcomes. Provide education and serve as a subject matter resource on HEDIS, Medicare Stars, NCQA standards, documentation requirements, quality reporting, and performance improvement strategies. Present performance results, best practices, and recommendations while maintaining strong relationships with providers, health plans, and internal stakeholders. Practice Transformation & Performance Improvement Support practice transformation initiatives through workflow analysis, process redesign, EHR optimization, documentation improvement, and population health management activities. Develop and implement improvement plans, identify performance barriers, and collaborate with providers and care teams to drive sustainable quality and operational outcomes. Support projects and initiatives designed to enhance service delivery, clinical quality, patient experience, and overall practice performance. Compliance & Operational Excellence Support quality audits, medical record reviews, and regulatory compliance activities in accordance with NCQA, CMS, HIPAA, and health plan requirements. Maintain accurate documentation of quality initiatives and provider engagement activities while identifying opportunities to improve operational effectiveness. Participate in provider, training, and organizational meetings and perform other duties or special projects as assigned.