Healthcare Quality Management Specialist (Remote)

Who We Are - Motivated by Purpose. Powered by Clinical Expertise.

Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

Excellence starts with our people.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

POSITION OVERVIEW

As a Quality Management Specialist, you will partner with key members of leadership for the design and implementation of Quality Management procedures, ongoing improvement efforts, and other team projects with the aim of achieving organizational, accreditation, and regulatory requirements. Based on measurement and analysis of trends, lead and support structured quality improvement initiatives (e.g., Lean, Six Sigma, DMAIC or equivalent) to reduce variation and improve performance outcomes, including reduction of errors, adverse events, or near misses and achievement of acceptable performance levels. 

Roles:

• Review and analyze current processes related to the application and implementation of policies, procedures, and practices; provide leadership with recommendations for updates to comply with the current regulatory and accreditation requirements. Identify gaps in efficient process workflow and suggests steps for quality process improvement. 
• Measure process performance using valid and accurate methods; analyze trends, variation, and process stability to determine if defined performance metrics are met and identify areas of risk. 
• Based on measurement and analysis of trends, lead and support structured quality improvement initiatives (e.g. DMAIC or equivalent) to address root causes, reduce variation, and improve performance outcomes, including reduction of errors/adverse events/near misses, or meet acceptable levels of performance. 
• Manage and lead Quality Improvement Projects (QIPs) ensuring defined problem statements, root cause analysis, measurable objectives, implementation, and validation of sustained improvement outcomes. 
• Manageand ensure execution of CAPAs, including documented root cause analysis, defined success metrics, implementation tracking, and post-implementation validation demonstrating sustained improvement in coordination with the Clinical Quality, Compliance, and Operations leaders. 
• Serve as liaison between clients and MRIoA’s quality management department as needed. 

Major Responsibilities or Assigned Duties:

• Assist leadership in establishing and reporting quality metrics and lead or support structured quality improvement initiatives using structured quality improvement methodologies (e.g., Lean, Six Sigma, DMAIC or equivalent). 
• Assist with the preparation, revision, and implementation of quality management policies and procedures. 
• Perform back-end internal audits to identify and resolve quality, workflow, and production issues and use findings to inform risk prioritization, and improvement initiatives. Ensure organizational, accreditation, and regulatory requirements are achieved.  
• Address and discuss issues and proposed solutions with leadership and document activities.  
• Work closely with all departments on complying with Quality Management requirements. 
• Take part in internal testing of software updates; collaborate with Information Technology to identify and correct issues. 
• Conduct root cause analyses using structured methodologies to identify underlying drivers and ensure corrective actions address systemic causes. 
• Apply quantitative and analytical methods to evaluate process performance, identify trends, variation, and systemic drivers, and assess effectiveness of improvement initiatives. 
• Establish control mechanisms to ensure sustained improvement and process stability. 
• Quantify and communicate impact of quality initiatives (e.g., error reduction, efficiency gains, compliance improvement). 
• Collaborate with leadership to prioritize initiatives based on risk, regulatory requirements, and performance data. 
• Manage the company Quality Management System including development, maintenance, enhancements, and user support, ensuring alignment with organizational quality processes. 
• Assist with the complaint process when requested; perform audits to ensure proper handling and classification of complaints and analyze complaint data to identify risk areas and support process improvement. 
• Evaluate and document the effectiveness of quality initiatives in meeting performance thresholds and standards; report findings and recommend improvements to leadership and governance bodies as appropriate; revise ineffective initiatives as necessary. 
• Prepare and present quality performance, audit results, and quality improvement initiatives to the Quality Management Committee; support facilitation of committee activities, including preparation of materials, tracking of action items, and follow-up on assigned deliverables as requested. 
• Communicate issues or concerns relating to internal or external quality matters to department leadership. 
• Ensure client satisfaction/enhancement activities are completed, including: 
• Deliver accurate data/metrics to internal stakeholders and ensure consistent and accurate communication of metrics to clients, regulatory, and accreditation bodies; 
• Track, monitor, and report client SLA metrics; manage remediation plans and CAPAs for SLAs not met in accordance with client contractual requirements; 
• Manage and support all other client CAPAs and remediation plans. 
• Coordinate resolution of top-level issues and provide coaching to teams about Quality Management process. 
• Complete and/or aids other internal or external audits as requested. 
• Complete other duties as requested. 

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.  Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only):

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com. 

Requirements:

Skills and Experience: 

• Minimum of 5 years’ experience in a quality management role 
• Demonstrated experience applying structured quality improvement methodologies (e.g., Lean, Six Sigma, DMAIC) required 
• Working knowledge of managed care and utilization review accreditation standards, including URAC and NCQA, and multi-state regulatory requirements  
• Six Sigma Green Belt or equivalent certification preferred 
• Exceptional customer service skills 
• Exceptional analytical and critical thinking skills 
• Excellent oral and written communication skills and interpersonal skills 
• Exceptional orientation to detail 
• Excellent organizational skills 
• Ability to work under pressure and meet deadlines while managing multiple high priorities and supporting a flexible schedule 
• Knowledge and understanding of the Company’s clients, products, departments, and workflows  
• Personal computer literacy and competency in use of Microsoft Word, Microsoft Excel (intermediate skill), Power Point and PowerBI  
• Ability to maintain a high level of objectivity and confidentiality  
• Experience in quality improvement activities within a healthcare, health insurance and/or managed care organization preferred 
• Experience in supplying small group and individual training preferred 
• Experience in research beneficial and preferred 

Education:



• High School Diploma 
• Preference for a bachelor’s degree or equivalent experience