Specialist, Care Quality

Specialist, Care Quality page is loaded## Specialist, Care Quality remote type:
On-Site locations:
Miami, FLtime type:
Full time posted on:
Posted Todayjob requisition :
JR3730

It's rewarding to be on a team of people that truly believe in making an impact!

We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.
** Job Summary
** The Care Quality Specialist is responsible for monitoring, analyzing, and improving healthcare quality performance across clinical facilities. This role supports organizational goals related to patient outcomes, regulatory compliance, and quality improvement initiatives by tracking key performance indicators, identifying gaps in care, and collaborating with multidisciplinary teams to implement corrective actions.
** Essential

Duties & Responsibilities
*** Monitor quality metrics such as HEDIS, STAR measures, CMS and NCQA guidelines, and internal performance indicators.
* Analyze care gaps and collaborate with providers, care teams, and pharmacy to close adherence and preventive care gaps.
* Support quality reporting processes including dashboards, data validation, and performance summaries.
* Conduct audits and chart reviews to ensure documentation of accuracy and regulatory compliance.
* Inform center staff on quality measures and best practices to improve patient care outcomes.
* Assist with the development and implementation of quality improvement plans and intervention strategies.
* Communicate findings and trends to leadership and assist in action planning.
* Maintain up-to-date knowledge of healthcare quality standards and industry requirements, including HIPAA.
** Additional

Duties & Responsibilities
*** Ability to multi-task efficiently and effectively.
* Communicate effectively by phone and in writing with providers, pharmacies, and patients.
* Adherence to all policies and procedures, including but not limited to standards for safety, attendance, punctuality and personal appearance.
* Participation in medical reviews, EMR updates and any additional training regarding medical documentation.
** Education & Experience
*** High School Diploma required.
** Preferred

Certifications:

*** Medical Assistant (MA).
* Pharmacy Technician (CPhT).
* Certified Professional Coder (CPC).
* Certified Risk Adjustment Coder (CRC).
* Nursing Student.
* Foreign Medical Graduate.
*
* Preferred Experience:

*** Experience working with HEDIS, CAHPS and HOS, STARS programs.
* Prior role in healthcare quality, care management, or clinical support.
* Knowledge of value-based care models, managed care, or population health.
* eCW and insurance Portals experience preferred.
** Education Requirements
**** Required/Preferred
**** Education Level
**** Discipline
* * Required High School Diploma
** Knowledge, Skills & Proficiencies
*** Fluent in English; bilingual (English/Spanish) preferred.
* Strong analytical and problem-solving skills.
* Proficient in data reporting tools, EMRs, and Microsoft Office.
* Ability to interpret NCQA Quality metrics and clinical documentation.
* Excellent communication and collaboration abilities.
* Strong organizational skills and attention to detail.
*
* Core Competencies:

*** Accountability and ownership.
* Critical thinking and process improvement mindset.
* Ability to work independently and as part of a team.
* Strong ethical standards and confidentiality awareness.
** Physical Requirements
** This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs.

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
** Work Conditions
** Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally…