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 enforcement of quality standards, monitoring clinical and operational performance, analyzing data and outcomes, and conducting audits and chart reviews. Responsibilities Interpret and comply with quality assurance standards. Ensure ongoing abidance by industry regulatory and quality requirements. Document and report 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 all 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. Maintain accurate documentation in Google Sheets or tracking logs. Perform routine specialized procedures, such as setting up iHealth products for patients under established protocols. Manage clinic inventories and medical supplies. Educate and advise patients on specific medical issues within established parameters, including obtaining prescription information. Direct patient flow following provider schedules / patient appointments. Coordinate 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. Qualifications and Skills 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. 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. Language Proficiency Bilingual – English/Spanish required. Physical Requirements May include occasional light lifting up to a 25‑pound limit, bending, stooping or squatting. Considerable walking may be involved. 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 represent those that must be met to perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. May be required to travel to all UCHC facilities as needed. Occasionally required to sit and walk. Finger dexterity and hand coordination required. Specific vision abilities required: close vision, distance vision, ability to adjust or focus. Work Environment Exposure to adverse conditions: extreme heat, extreme cold, wet/humid conditions, moving mechanical parts, high or precarious places, fumes or airborne particles, toxic or caustic chemicals, outside weather conditions, electrical shock, explosives, radiation or vibration. Protective clothing or equipment required: gloves, helmets, steel‑toed boots, protective eyewear. The noise level typically is high. #J-18808-Ljbffr HDM