Denverhealth · DenverPrepare for this interview
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We are recruiting for a mission-driven NCQA Specialist/ Quality Improvement - Denver Health Medical Plan (* Weekly Hybrid Schedule Requirement *) to join our team! We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration Join a highly visible and impactful Quality Improvement team where NCQA accreditation and regulatory excellence are at the core of our work. As an NCQA Specialist, you will play a critical role in driving accreditation readiness, leading documentation management, and supporting end-to-end audit preparation across the organization. This role partners closely with cross-functional teams-including Clinical, Operations, Compliance, and Population Health-to ensure alignment with evolving National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), and Colorado Department of Health Care Policy and Financing (HCPF) requirements. You will help shape and maintain work plans, track compliance activities, and ensure audit-ready documentation across hundreds of standards and elements. This is an ideal opportunity for someone who thrives in a detail-oriented, fast-paced environment and wants to deepen their expertise in accreditation, regulatory strategy, and quality improvement infrastructure. Beyond execution, you'll contribute to building sustainable processes, strengthening organizational readiness, and supporting continuous improvement efforts that directly impact member experience and plan performance. If you are passionate about quality, accountability, and making a measurable difference in healthcare delivery, this role offers both challenge and meaningful growth. Job Summary The Quality Improvement (QI) Specialist supports the design, implementation, and evaluation of quality initiatives that enhance member outcomes, strengthen provider performance, and ensure compliance with regulatory requirements. This role is critical in advancing health plan performance across HEDIS, Medicare Stars, CAHPS, and Colorado Medicaid quality programs, while supporting NCQA accreditation and other compliance activities. The QI Specialist collaborates with cross-functional teams and external stakeholders to drive measurable improvements in clinical care, operational processes, and member experience. Essential Functions : Colorado Medicaid Quality Programs: Ensure compliance with HCPF quality requirements, including performance improvement projects (PIPs), External Quality Review Organization (EQRO) reporting, and population health initiatives. (20%) NCQA & Compliance: Support National Committee for Quality Assurance: (NCQA) accreditation readiness and regulatory audits by maintaining accurate documentation and work plans. Stay current on Centers for Medicare & Medicaid Services (CMS), NCQA, and Health Care Policy and Financing (HCPF) guidelines. (5%) Population Health & Outcomes: Partner with care management, pharmacy, and provider networks to design and implement quality interventions that improve outcomes and reduce disparities. (10%) Process Improvement: Apply quality improvement methodologies (e.g., PDSA, Lean, Six Sigma) to evaluate workflows, streamline processes, and enhance operational efficiency. (15%) Member & Provider Experience: Collect and analyze feedback (CAHPS, surveys, advisory groups) to inform strategies that improve access, coordination, and satisfaction. (10%) Data Analysis & Reporting: Develop dashboards, reports, and presentations for leadership, committees, and external stakeholders, ensuring accuracy and timeliness. (20%) Committee Participation: Facilitate or support quality committees, workgroups, and cross-departmental projects 15focused on clinical and operational improvement. (20%) Education : Bachelor's Degree Public Health, Nursing, or related field required Work Experience : 4-6 years' experience in health plan quality improvement, with direct experience in HEDIS and Stars required Licenses : CPHQ-Certified Professional Healthcare Quality - NAHQ - National Association for Healthcare Quality GREENBELT-Green Belt - SSGI - Six Sigma Global Institute Knowledge, Skills and Abilities : Familiarity with Colorado Medicaid quality programs, HCPF requirements, and EQRO processes. Demonstrated knowledge of NCQA accreditation standards, CMS requirements, and managed care operations. Strong data analysis and reporting skills (Excel required; Tableau, SAS, or other tools preferred). Excellent communication and project management skills with ability to influence cross-functional teams. Strong Verbal and written skills * This is a hybrid role with a weekly in-office requirement in Denver, Colorado Shift Days (United States of America) Work Type Regular Salary $79,400.00 - $123,100.00 / yr
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