About the Role
Position Summary: The Quality Improvement Coordinator II plays a key role in implementing and supporting quality improvement programs across all lines of business. This includes contributing to the development and execution of the annual program description, work plan, and annual evaluation. The role involves a variety of moderately complex administrative, operational, and customer support activities, including data computation and process monitoring.
Key Responsibilities:
Support the implementation and management of quality improvement initiatives aligned with organizational goals.
Monitor quality investigations and ensure compliance with regulatory and internal standards.
Manage departmental systems and tools including the quality management system, SharePoint sites, and internal reporting processes.
Perform audits and quality reviews to assess compliance and identify areas for improvement.
Prepare and submit required documentation and reports to regulatory bodies such as CMS and state agencies.
Interpret departmental policies and procedures to guide decision-making and workflow prioritization.
Operate with a degree of autonomy while adhering to established standards and processes.
Requirements
Required Qualifications:
Experience in a fast-paced insurance or healthcare environment
Background in provider relations and education
Solid understanding of healthcare quality measures (e.g., STARS, HEDIS)
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
Strong analytical and problem-solving skills
Excellent written and verbal communication abilities
Demonstrated ability to build and maintain professional relationships
A strong commitment to enhancing the consumer experience through continuous quality improvement
Preferred Qualifications:
High School Diploma or equivalent
Familiarity with healthcare industry regulations and internal operational procedures
About the Company
RepuCare, a certified Woman-Owned Business Enterprise (WBE), is a leader in delivering innovative workforce solutions across the healthcare industry. We are proud to partner with a large, nationally recognized managed care organization to recruit a dedicated Quality Improvement Coordinator II to join their dynamic team.