Clinical Quality and Program Evaluation Specialist

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Job Description:

OVERVIEW OF POSITION:

The Clinical Quality and Program Evaluation Specialist supports Colorado Community Health Alliance (CCHA)’s Medicaid members by playing a critical role in driving quality improvement and demonstrating the impact of clinical programs through rigorous evaluation. The specialist will leverage data and best practices to enhance organizational efforts, ensure compliance, and promote health equity.

• Up to 30% travel with in-office expectations at least 4 days per month)

• Colorado residency is required for this position

ESSENTIAL DUTIES:

• Creates data-driven strategies utilizing clinical best practices to drive organizational efforts to achieve targeted key performance indicators and performance standards.
• Works with Clinical, Informatics, and Health Care Economics teams to develop and implement reports, dashboards, and other data requests to support internal and external clinical performance.
• Guides CCHA interpretation and use of data to drive action in a manner that is easy to understand and facilitates improvement at all levels.
• Works with Clinical Operations, Practice Success, and Analytics teams to evaluate practice-based interventions and programs.
• Develops and implements comprehensive program evaluation plans for clinical initiatives, including defining measurable outcomes and establishing data collection protocols.
• Designs and conducts needs assessments to identify gaps and opportunities for new or improved clinical programs, with particular emphasis on condition management.
• Leads the collection, analysis, and interpretation of data to assess program effectiveness, efficiency, and impact on patient outcomes and health equity.
• Prepares detailed evaluation reports and presentations for internal and external stakeholders, translating complex findings into actionable insights for program managers and leadership.
• Develops and monitors program logic models to clearly articulate program inputs, activities, outputs, and desired outcomes.
• Facilitates the use of evaluation findings to inform program design, policy decisions, resource allocation, and continuous quality improvement cycles.
• Partners with marketing specialists to help communicate findings to key stakeholders including but not limited to members and community partners.
• Contributes narrative and data to support deliverables and audits regarding clinical programs, outcomes, and performance.
• Partners with Clinical Operations team to use data to inform the development and evaluation of clinical programs such as maternity and transitions of care.
• Co-designs and facilitates health equity committees; responsible for sharing learnings with CCHA.
• Represents CCHA at state meetings regarding health equity data and clinical outcomes.
• Co-develops the Health Equity Annual Plan.
• Responsible for gathering, interpreting, and reporting clinical and quality outcomes health equity data that drives actionable change.
• Adheres to the company’s Compliance Program and to federal and state laws and regulations, including HIPAA.
• Participate in special projects and perform other duties as assigned.
• Maintains confidentiality and ensures compliance with HIPAA regulations
• Other duties as assigned

EDUCATION:

Bachelor’s degree in healthcare related field or equivalent experience in health care, quality improvement and data analytics.

Master’s degree in business, Public Health, Public Administration, Health Administration or related field preferred.

EXPERIENCE:

• 3-5 years of experience working to implement data driven clinical programs in a clinical setting, such as a primary care practice, FQHC, or hospital

• 3-5 years of experience developing clinical programs to support HEDIS, CQM, eCQM, MIPS, PCMH, MU, and/or HRSA UDS

• 3-5 years of clinical and quality data manipulation, analysis, and outcome measurement

• Extensive experience with building actionable reports in PowerBI

KNOWLEDGE, SKILLS, ABILITIES:

• Knowledge of Medicaid, Medicare, healthcare delivery systems and value-based care programs and payment
• Excellent communication and interpersonal skills necessary to effectively interact with all levels of the organization and external entities
• Superior project management and organizational skills; able to juggle multiple projects that greatly differ in subject matter
• Strong facilitation skills for small and large group engagements
• Remain flexible in work schedule to provide the most effective and efficient support for the organization and practices
• Ability to manage multiple priorities and deadlines effectively
• Ability to establish and maintain effective working relationships with others
• Home office, that is HIPAA compliant for all remote or hybrid work arrangement positions as outlined by the company policies and procedures

Salary Range:

$52,353.60- $69,804.80