Quality Specialist - St. Luke's Health Plan

e’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.

As a
Quality Measure Specialist
, you'll play a critical role in advancing quality performance, regulatory excellence, and member experience through the successful execution of HEDIS, NCQA, CMS Star Ratings
, and other key quality initiatives.

As part of our Quality team, you'll help ensure the accuracy, integrity, and impact of the data that drives healthcare quality improvement. Working across clinical, operational, and vendor partners, you'll support programs that improve member outcomes, strengthen regulatory compliance, and increase organizational performance.

In this role, you will have the opportunity to:

• Drive quality measurement and improvement efforts by supporting HEDIS, NCQA, CMS Star Ratings, and other regulatory and performance initiatives.
• Review, abstract, and validate clinical data from electronic health records, medical records, and care management systems to ensure accurate and compliant quality reporting.
• Identify documentation gaps, data discrepancies, and improvement opportunities that impact quality performance, audit readiness, and measure outcomes.
• Partner with providers, vendors, and internal stakeholders to gather information, resolve data issues, and strengthen documentation and reporting practices.
• Coordinate quality projects, action plans, reporting activities, and operational deliverables that support organizational quality goals.
• Maintain audit-ready documentation, validation records, supporting evidence, and reporting logs for regulatory reviews, compliance audits, and delegated oversight activities.
• Monitor evolving quality measurement requirements and technical specifications, helping teams translate changes into operational improvements and sustainable processes.
• Contribute to initiatives that enhance measurement accuracy, data integrity, reporting reliability, and overall quality performance.

• Education:
  
  Bachelor’s degree or experience in lieu of degree

e’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.

As a
Quality Measure Specialist
, you'll play a critical role in advancing quality performance, regulatory excellence, and member experience through the successful execution of HEDIS, NCQA, CMS Star Ratings
, and other key quality initiatives.

As part of our Quality team, you'll help ensure the accuracy, integrity, and impact of the data that drives healthcare quality improvement. Working across clinical, operational, and vendor partners, you'll support programs that improve member outcomes, strengthen regulatory compliance, and increase organizational performance.

In this role, you will have the opportunity to:

• Drive quality measurement and improvement efforts by supporting HEDIS, NCQA, CMS Star Ratings, and other regulatory and performance initiatives.
• Review, abstract, and validate clinical data from electronic health records, medical records, and care management systems to ensure accurate and compliant quality reporting.
• Identify documentation…