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Quality Improvement Specialist Resume Samples
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0-5 years of experience
Trained sales agents in improved selling strategies as well as current compliance standards. Partnered with Sales Supervisors to develop individualized action plans for employees to boost performance and productivity. Spearheaded compliance workshops to ensure all agents were supported in meeting expectations and received constructive feedback.
- Received highest performance rating (“Excelling”) on final review prior to company shut down.
- Piloted Quality Coach role stemming from extensive management experience. Drove 10%+ increase in sales and compliance performance by veteran agents through targeted training and feedback.
- Created up-to-date compliance reference materials and led training for five classes of agents.
- Provided one-on-one training for new Sales Supervisors to expedite onboarding and enhance knowledge and leadership skills.
- Monitored live and recorded customer calls to provide immediate opportunity feedback.
- Resolved complaints from state insurance departments and national accounts through collaboration with key team members and departments.
- Served as compliance subject matter expert (SME) to management and coached new Quality Improvement Specialists on policies and procedures.
0-5 years of experience
Major focus on leading and executing a mixed portfolio of strategic initiatives, projects and programs to deliver improvements to quality, reliability, safety and satisfaction of resident/employee experience.
- Defines, develops and builds out infrastructure and standards to execute projects including methodologies, tools and templates
- Teach and coach performance improvement and project management effectively, working with frontline and middle management staff to improve their knowledge, capacity and process improvement tools to solve problems
- Act as a change agent, and builds and manages relationships across the organization
- Helps implement and sustain visual management systems and reviews at all levels across the organization
- Preform process improvement project organization, analysis and implementation, and utilizes scheduling, project task lists, milestone tracking/reporting, etc.
0-5 years of experience
- Provided technical expertise and coordination for improving health plan core measures and key performance indicators related to Medicare-Medicaid line of business to senior leadership team, including identifying gaps in performance as well as regulatory and legislative interpretation.
- Effectively collaborated with Compliance Program Oversight Unit staff by performing qualitative and quantitative analysis to identify gaps in plan performance, development of improvement plans and measurement to assess impact of actions.
- Managed and facilitated the implementation of DHCS performance improvement activities that lead to a positive and measurable impact on process and outcomes measures.
- Provided support to the QI Director to track, monitor, report, and trend performance related to planning, development and operations of the Compliance program.
- Participated in NCQA accreditation and regulatory audit preparedness and maintained activities, including preparing reports, narratives, graphs as needed for external audits and surveys related to specific topic areas.
0-5 years of experience
- This role functioned as an hospital Quality (Performance Improvement, Infection Prevention) subject matter expert for coordinated, statewide initiative to reduce hospital acquired infections (HAI), Readmissions, Sepsis coordination, Length of Stay and more with the goal of reducing overall patient harm and enhancing patient & family experience in healthcare.
- In charge of 21 facilities’ compliance and served as a Liaison for best practices.
- Arrange and facilitate monthly collaborative calls as required by project deliverables
0-5 years of experience
- Member of a team of specialists assigned to statewide coverage of Georgia, for a major Medicare/ Medicaid managed care organization. Activities include on-site, electronic transmission and other means of completing audits.
- Monitor Quality Improvement initiatives to ensure compliance with HEDIS measure set standards.
- Perform medical record reviews utilizing clinical specialization specific criteria; facilitate educational support to providers regarding appropriate clinical documentation commensurate with high quality patient care.
- Collect and summarize performance data, identify and counsel provider about opportunities for improvement.
0-5 years of experience
- Perform data analysis and reporting for health plan’s quality improvement initiatives.
- Utilize a variety of reporting tools to analyze, verify and compile member data.
- Analyze quality performance score cards and report opportunities for improvement to management.
- Create weekly, monthly and ad-hoc reports for Medicare and Marketplace product lines.
- Assist with verification and cleansing efforts to maintain data integrity and quality.
0-5 years of experience
- Facilitates, trains, and leads the development and implementation of improvement programs within assigned areas/department microsystems to achieve efficient healthcare across the continuum of care
- Demonstrates a comprehensive understanding of the theory and principles of clinical performance/ transformational improvement while adhering to stringent quality measures and regulations
- Conducts didactic training sessions for providers, administration, professional and front line staff
- Active member of inpatient and outpatient regulatory mock tracers
0-5 years of experience
- Track and Trend all incentive attestations within the Member Incentive Program
- Created an internal survey for MLTC, FIDA, & Medicare. Up to and including methodology, tracking, and coordinating with the vendors, criteria, exclusions, timelines
- Draft and assist in creating the member newsletter; also created topic outline by seasons, and adjusted the reading grade level for all MLTC & FIDA population
- Created educational content for organizations social media page to be posted by corporate communications
- Request, reviewed, and compared various vendor proposals for services
- Conduct monthly internal IQC audits on Care Managers with new enrollee’s (including the welcome call within week one, home visits within first 30 day, and member call to PCP ratio within first 30 days)
- Responsible or sending out LHCSA (Licensed Home Care Service Agencies) score cards quarterly to all participating LHCSA’s
- New hire orientation training for Human Resources to update and educate new hires on the Quality Management Department
- Conduct Root Cause analysis of Missing 6 month UAS reassessments, for Utilization Management to determine gaps and delay(s).
- Assist with all HEDIS initiatives, including the HEDIS Roadmap, onsite audit, working with contracted vendors, and assisting with the IDSS filing.
0-5 years of experience
- Schedule and manage all interior and exterior accounts
- Perform quality checks on interior and exterior accounts
- Perform reviews with clients to guarantee satisfaction
- Assist in the install and design of plants for new accounts
- Input and manage the inventory
0-5 years of experience
- Provides administrative support for routine correspondence related to quality initiatives, including fax, scanning, email, and hard-copy of correspondence.
- Conducts telephonic outreach to members to support ongoing quality initiatives.
- Provides coordination and support for medical records retrieval.
6-10 years of experience
- Lead practices in complying with Rural Health Center regulations set forth by CMS
- Manage and monitor the BCBSM Patient Centered Medical Home program
- Implemented the CMS Meaningful Use program for both specialists and primary care
- Monitor and manage the quality work plan for the Sparrow Carson Primary Care Physicians
- Create quarterly quality reports and present findings regularly to physicians and providers in collaboration with the quality work plan
- Perform chart audits to meet Rural Health Clinic specifications
- Oversee the insurance incentive programs for BCBSM, BCN, Priority Health, Meridian Health Plan and McLaren
- Update policies and procedures on a regular basis
0-5 years of experience
- Conduct outreach to licensed, home-based programs and providers to support them in submitting their Self-Assessment Survey and completing a Quality Improvement Plan.
- Conduct on-site visits to help build provider knowledge and understanding of Great Start to Quality (GSTQ).
- Provide onsite technical assistance to licensed, home-based early childhood providers
- Support providers in updating their provider profiles.
- Promote public awareness of quality improvement resources available through Great Start to Quality to increase participation in GSTQ.
- Assist in organizing quarterly child care conferences.
- Attend Community Outreach events to promote GSTQ.
- Develop, organize and facilitate Peer to Peer Network Group Meetings.
- Provide outreach to eligible Child Development and Care (CDC) subsidy families to assist them in securing enrollment in high-quality early learning and development programs.
- Complete tracking logs/reports/electronic database daily/weekly/monthly as needed
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[Quality Improvement Specialist]
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
