Quality Improvement Specialist

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement, and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit Amidacareny.org for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative, and experienced leader to join our team as the Quality Improvement Specialist. Compensation will be commensurate with experience.

Position Summary:

The Quality Improvement Specialist (QIS) is responsible for monitoring the activities designed in the organization's annual Quality Management Program. This includes the collaboration, implementation, and monitoring of initiatives and projects aimed at meeting QMP goals, improving health outcomes, addressing gaps in care, and supporting state and local reporting requirements. The position ensures the successful execution of quality improvement activities, collaboration with stakeholders, and the achievement of regulatory compliance across various quality initiatives.

Responsibilities:

• Lead the collaboration, development and execution of projects and initiatives designed to achieve the goals of the Quality Management Program (QMP). Ensure alignment with strategic priorities for improving care quality and health outcomes.
• Monitor key health outcomes and lead efforts to resolve HEDIS (Healthcare Effectiveness Data and Information Set) gaps-in-care, ensuring timely and accurate submission of data and compliance with reporting requirements.
• Serve as the primary liaison between internal teams, external stakeholders, and vendors to implement initiatives that improve access to care and the quality of services provided to AmidaCare members.
• Build and maintain strong relationships with key provider partners to advance quality goals. Facilitate the sharing of necessary data and information to support ongoing quality improvement projects.
• Support the maintenance, updating, and revision of the Quality Management Program document to ensure it reflects current practices, regulations, and organizational goals.
• Participate in the preparation and response to state audits, ensuring that all required documentation and evidence of compliance are thoroughly prepared and available for review.
• Develop targeted action plans, utilizing the PDSA (Plan-Do-Study-Act) model, to address areas of deficiency identified in program performance and evaluation reports from the New York State Department of Health (NYSDOH).
• Facilitate monthly Quality Improvement (QI) workgroups and meetings to ensure consistent adherence to quality interventions, accurate reporting, and operational protocols.
• Track and monitor the execution of quality improvement activities to ensure compliance with quality standards and that corrective action plans are implemented and completed on schedule.
• Utilizing various software applications to support department operations and accurately entering the results of chart audits into the of mandated HEDIS and State performance measures.
• Perform other duties as assigned.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

EDUCATION REQUIRED

• Master's degree in public health or bachelor's degree with a certification as a Licensed Practical Nurse (LPN).

EXPERIENCES AND/OR SKILLS REQUIRED

• At least three (3) years' experience working in managed care.
• Proven experience in quality management, health outcomes improvement, and regulatory reporting.
• Strong project management skills with the ability to manage multiple initiatives simultaneously.
• Experience in developing action plans based on data analysis and using quality improvement models like PDSA.
• Excellent communication and relationship-building skills, with the ability to engage and collaborate with internal and external partners.
• Knowledge of HEDIS, NYSDOH reporting, and quality improvement requirements preferred.
• Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.