Quality Management Generalist

Quality Management Generalist 1 – Bakersfield Family Medical Group

Under the direction of the Senior VP of Operations, this position supports the Quality Management team with year‑round HEDIS/P4P/CMS star activities, emphasizing Medication Adherence and Part D Measures. Duties include data collection and medical record extraction, and interacting with clinic personnel and outside providers to maintain positive relationships with internal and external customers.

• Communicate effectively, verbally and in writing, with members, providers and health‑plan representatives.
• Be familiar with all manuals (HEDIS, P4P, CMS) and have a firm understanding of all quality measures and their criteria.
• Work with QM staff to complete all requirements related to HEDIS data collection and submission.
• Collaborate with members of the Quality Department and Clinical Operations to pursue compliance with HEDIS/P4P/CMS Star measures.
• Work with the Clinical Quality Specialist to analyze pharmacy data from QMetrics and health‑plan websites, identify gaps in care for Part D adherence measures, and outreach to pharmacies and members to address barriers to compliance.
• Outreach to BFMC/CCPN members to schedule preventive screenings for providers with standing orders, and ensure results are received and forwarded to the PCP.
• Review medical records and extract data to meet measurement compliance.
• Ensure lab orders initiated by the Quality Department are signed off and forwarded to their PCP.
• Maintain working knowledge of the QM systems.
• Assist the Quality team with offsite mammogram and quality gap‑closure clinics, as well as in‑home screenings.
• Maintain a professional working relationship with BFMC/CCPN providers and their staff, and serve as a resource for QM related topics.
• Maintain patient confidentiality and follow HIPAA guidelines at all times.
• Attend all staff meetings and complete in‑service trainings and monthly trainings as required.
• Complete cultural and linguistic training annually.
• Perform other duties as assigned.

• High School Diploma / GED equivalent.
• Medical office experience preferred.
• Working knowledge of HEDIS/P4P/CMS Star measures and requirements.
• Clean DMV record – current CA driver’s license and vehicle insurance.
• Good organizational and time‑management skills.
• Courteous and polite communication style.
• Computer skills:
  Microsoft Office, Excel, EMR systems.

Pay range: $24.27 – $28.55 per hour. The base pay offered may vary based on market location, job‑related knowledge, skills, and experience.

Employee will be in an “at‑will” position. The Company reserves the right to modify base salary and any other discretionary payment or compensation program at any time.

Equal Opportunity Employer – Minorities / Women / Protected Veterans / Disabled.

Entry level

Full‑time

Human Resources