QA QI Specialist

Job Title Quality Assurance and Quality Improvement (QAQI) Specialist Department Non-Clinical Reports To Senior Program Director FLSA Status Non-Exempt Summary QAQI Specialist provides oversight of programmatic and interventional activities in accordance with contractual, regulatory requirements. QAQI professionals are ultimately responsible for guaranteeing the quality of products and services. Their day-to-day work involves careful inspections and the enforcement of quality standards from monitoring clinical and operational performance, analyzing data and outcomes, and conducting audits and chart reviews. General Accountabilities Interpret and comply with quality assurance standards. Ensure ongoing abidance by industry regulatory and quality requirements. Documenting and reporting product or service quality levels. Achieve a strong working knowledge of all company policies and procedures. Collaborate with clinical, administrative, and leadership teams to improve workflows, patient outcomes, and service delivery. Complete health risk assessments as necessary. Monitor IPA data reporting requirements and upload all data to various IPA and payor data portals. Monitor all payer portals and respond to insurance-driven requests for data, working with the clinical team as necessary to complete data requests. Conduct random chart audits for the clinical team. Data entry, Answer, refer and/or follow-up via telephone, fax, email and mail with patient questions related to the program and specific needs of the patients. Triage to the appropriate Care team. Maintains accurate documentation in google sheets or tracking logs. Performs routine specialized procedures, such as setting up the iHealth products for the patients under established protocols. Manages clinic inventories and medical supplies. Educates and advises patients on specific medical issues within established parameters to include obtaining prescription information. Directs patient flow following provider schedules/patient appointments. Coordinates routine office activities and administrative functions to support clinic activities. Assist with special projects, community health initiatives, and organizational improvement efforts aligned with UCHC. Other duties assigned by the Senior Program Director. Job Qualifications College degree preferred, but not required if candidate has relevant work experience. Relevant long-term experience, knowledge of regulatory requirements. Knack for implementation of corrective action programs. Experience in eCW preferred. Superb computer competence, including experience with databases and Microsoft Office. Knowledge of QA terms, tools, and methodologies. Skills Strong knowledge of quality assurance standards, regulatory compliance, and industry requirements. Ability to interpret, document, and report on product or service quality metrics. Experience with health risk assessments and patient monitoring protocols. Proficient in data entry, tracking, and management using databases such as Google Sheets and electronic health record systems (e.g., eClinicalWorks). Ability to monitor and upload data to IPA and payer portals and respond to insurance-driven requests. Skilled in conducting chart audits, analyzing findings, and recommending corrective actions. Competence in implementing corrective action plans and process improvements. Strong organizational and administrative skills to coordinate office and clinic activities. Ability to educate and advise patients within established medical parameters. Competence in managing clinic inventory, medical supplies, and specialized equipment. Excellent communication and triage skills for responding to patient questions via phone, fax, email, or mail. Attention to detail and accuracy in documentation, reporting, and patient records. Ability to work collaboratively with clinical teams to ensure quality and compliance. Skills: Language Bilingual-English/Spanish is required. Physical Requirement Physical effort which may include occasional light lifting to a 25 pound limit, and some bending, stooping or squatting. Considerable walking may be involved. The ability to sit or stand for extended periods of time is required. Flexibility to work in multiple locations throughout the week. The 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 accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee may be required to travel to all UCHC facilities as needed. Occasionally required to sit and walk. Finger dexterity required. Hand coordination required. Specific vision abilities required for this job include: close vision, distance vision, ability to adjust or focus. Work Environment Exposure to adverse conditions. Exposure to extreme heat. Exposure to extreme cold. Exposure to wet and/or humid conditions. Exposure to moving mechanical parts. Exposure to high, precarious places. Exposure to fumes or airborne particles. Exposure to toxic or caustic chemicals. Exposure to outside weather conditions. Possible risk of electrical shock. Exposure to explosives. Possible risk of radiation and vibration. Protective clothing or equipment is required including: gloves, helmets, steel-toed boots, protective eyewear. The noise level in the work environment usually is high. Acknowledgement I understand that I may be asked to perform job-related duties not listed in the description and that my duties may change at any time, according to the UCHC needs. Nothing in this position description is intended to create a contract of employment of any type. Employment is strictly on an at-will basis. #J-18808-Ljbffr