Quality Improvement Specialist CA Remote

Job Type Full-time Description

Who We Are

Innovative Integrated Health (IIH) is a mission-driven healthcare organization dedicated to helping frail, underserved, and multiethnic seniors live safely and independently at home with dignity. Through the Program of All-Inclusive Care for the Elderly (PACE) model of care, we deliver high-quality, personalized healthcare and supportive services that improve quality of life across the communities we serve.

At IIH, our work is rooted in compassion, cultural understanding, and deep respect for those in our care. Team members play a vital role in supporting seniors throughout Central and Southern California—delivering care that’s not only clinically excellent, but also personal, coordinated, and community-based.

When you join IIH, you become part of a team committed to making a real difference in the lives of older adults—every single day.

Benefits

• 401(k) 
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Job Summary

The Quality Improvement (QI) Specialist supports the ongoing development, implementation, and evaluation of IIH’s Quality Improvement program. The QI Specialist specializes in data collection and processing of key functions related to the QI program.  In addition, this role will also support IIH’s Provider Network department which includes managing provider data associated with contracts as well as provider credentialing.  

Essential Job Functions

Duties include, but are not limited to:

• Collect and organize QI data related to participant health outcomes, service delivery and satisfaction.
• Track and report incidents, grievances, hospitalizations, and infection control data.
• Support the coordination of QI initiatives and activities.
• Prepare reports, presentations and meeting materials for QI committees.
• Participate in Quality Improvement activities and initiatives utilizing QI methodology such as Plan Do Study Act (PDSA).
• Participate in internal audits, chart reviews, and compliance monitoring as directed.
• Maintain organized records and documentation for regulatory compliance.
• Assist with basic training materials and communications on quality initiatives for staff.
• Manage provider data including contracts across various systems (i.e. EMR, Claims, and Provider Data Management Systems) impacting clinic, operations, claims and provider network.  
• Work with Credentialing Verification Organization to ensure all contracted providers in the network are credentialed.  
• Perform ongoing monitoring and quality checks on provider data including Medical Board licensing, CMS Preclusion, Medi-Cal S&I, Medicare Opt-Out, NPDB as well as quality reviews of Residential Care Facilities for Elderly (RCFE). 
• Ensure all key operational departments (Patient Access, Claims, Clinic, Intake etc.) have the most up-to-date provider information disseminated via provider directory or on the website.
• May be required to use personal vehicle. If using a personal vehicle, a valid California Driver’s License and proof of vehicle insurance are required. 

Knowledge, Skills and Abilities

• Establish and maintain effective working relationships with providers and staff at all levels.
• Familiarity with the healthcare delivery system related to Quality and Provider Network data, plus the ability to review and analyze data to ensure its integrity.
• Proficient knowledge of software such as Office 365: Teams, SharePoint, Excel, Outlook, and Word; and general database functionality.
• Excellent communication skills, both orally and in writing.
• Strong organizational and time-management skills.
• Must work in compliance with all HIPAA, CMS, and DHCS requirements.
• Ability to quickly learn new processes, policies, and procedures.
• Ability to be flexible, multi-task, and pay attention to details.

Working Conditions and Physical Demands

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Ability to communicate verbally particularly for regular phone use.
• Ability to sit for extended periods of time, as well as work at the computer for long periods of time.
• Employees are required to use hands and fingers, especially for typing on the computer and using mouse for long periods of time.
• Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air- conditioned environment.

Requirements

Experience

• Minimum of one (1) year working in Quality Management for a health plan, and experience with QI methodologies and data management/systems is strongly preferred.
• Minimum of one (1) year of experience working with provider data, provider relations, provider contracting, health plan operations, or other health care/medical office environment is strongly preferred.

Education And Certification

• Bachelor’s degree is required.
• Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact. 

Core Values

• Respect at the core of our interactions.
• Honesty and Integrity with every endeavor
• Patient – Centered care aligned with participant values, beliefs, and preferences.
• Encouragement that motivates and empowers others to be the best they can be.
• Quality Care that is efficient, transformative, and innovative.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. 

Salary Description $26 -$32/hr