Quality Care Improvement Specialist I

QCI Specialist I

Department: Quality - Risk Adjustment

Employment Type: Full Time

Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919

Reporting To: Leigh Nyahe

Compensation: $25.00 - $29.00 / hour

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.

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

• 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.

• 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.

• 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.

• 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.

• Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, or a related field preferred, or equivalent combination of education and relevant experience.

• At least 3 years of experience in healthcare, managed care, population health, quality improvement, provider engagement, or related healthcare programs.
• At least 1 year of experience supporting HEDIS, quality improvement, Medicare Stars, or quality reporting initiatives.
• Experience working with provider practices, IPAs, MSOs, health plans, or outpatient clinical settings preferred.
• Experience analyzing provider performance data and supporting quality improvement interventions preferred.
• Familiarity with practice management operations, workflow improvement, and population health strategies preferred.

• No certification is required.
• Certified Professional in Healthcare Quality (CPHQ) or other relevant healthcare quality certification preferred.

• Strong knowledge of managed care operations, quality improvement programs, HEDIS, Medicare Stars, NCQA standards, HIPAA requirements, population health management, and quality reporting methodologies.
• Working knowledge of quality measure specifications, practice transformation, workflow redesign, EHR optimization, and documentation improvement strategies.
• Strong analytical, critical-thinking, problem-solving, and organizational skills, with the ability to identify opportunities, implement solutions, and manage multiple priorities effectively.
• Excellent provider relationship management, stakeholder engagement, communication, presentation, and interpersonal skills, with the ability to work independently and collaboratively…