Quality Operations Specialist
Job Summary
Collaborating with the Manager, the full-time remote Sr. Associate, Quality Operations will drive quality performance in alignment with organizational objectives by managing payor relationships, supporting quality initiatives, and delivering centralized support to clinical teams.
Key responsibilities
- Serve as Quality SME for HEDIS/Stars specifications and lead quality meetings with payor partners
- Act as liaison for external vendors, overseeing performance and ensuring adherence to contractual expectations
- Provide centralized quality support, analyze metrics, and collaborate with market teams to achieve performance goals
Required qualifications
- Bachelor's degree
- 3+ years of experience in HEDIS/Stars and broader quality improvement or management
- 3+ years of experience in Medicare, ACA, Marketplace, and/or Medicaid lines of business
- Experience managing external partner relationships with a focus on contractual oversight and quality data analysis
- Experience in designing or improving operational workflows in a healthcare quality setting; CPHQ certification is a plus
Complete Job Description
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