quality improvement specialist

Firelands Physician Group

<div><h4 class="jobSectionHeader">GENERAL SUMMARY AND SCOPE</h4>

The Clinical Improvement Specialist is responsible for understanding and improving clinical care, population health and quality program requirements. The scope of work will include monitoring, reporting and improving patient care opportunities, documentation workflows, patient satisfaction and ambulatory clinical processes.
<h4 class="jobSectionHeader">
ESSENTIAL TASKS, DUTIES AND RESPONSIBILITIES</h4>
<ul><li>Understand, design and improve clinical workflow processes in practices, assuring exceptional patient care and high user satisfaction</li>
<li>Responsible for establishing, managing, and maintaining clinical workflow process across the continuum, including the documentation and report requirements needed to meet a variety of program guidelines</li>
<li>Monitor and prepare patient satisfaction reports to support patient advocacy activities within FPG administration</li>
<li>A clinical administration liaison for new technologies to improve patient care and business operations</li>
<li>Accepts accountability to manage assigned quality initiatives and utilizes performance improvement processes to facilitate planned change</li>
<li>Works to streamline concurrent quality program requirements to enhance care processes to improve patient outcomes and compliance with best practices</li>
<li>Aggregates data and provides reports that are timely, pertinent, reliable, and accurate to report positive and negative findings to administration and staff teams to facilitate improvement as needed</li>
<li>Performs quarterly safety site assessments and communicates deficiencies as needed to Operations Managers</li>
<li>Monitors safety and compliance dashboards for patient safety and coordinates improvement activities as it relates to deficiencies</li>
<li>Participates in and coordinates audit preparedness activities</li>
<li>Monitoring of quality and population health data through system dashboards working to improve accuracy and proper data capture</li>
<li>Effectively works interdepartmentally to achieve quality department goals and program requirements</li>
</ul> <h4 class="jobSectionHeader">KNOWLEDGE, SKILLS AND ABILITIES</h4>
<ul><li>License/certification in a healthcare related field required. Bachelor&rsquo;s degree in a healthcare or informatics field strongly preferred.</li>
<li>Five (5) years&rsquo; experience in healthcare environment required.</li>
<li>Clinical information systems and training experience required.</li>
<li>Working knowledge of computer systems and associated software applications required.</li>
<li>Skilled in exercising initiative, judgment, problem solving, and decision making.</li>
<li>Skilled in analysis and interpretation of data, and preparation of reports.</li>
<li>Skilled in time management and organization. Ability to prioritize and meet deadlines.</li>
<li>Governmental regulations and compliance requirements.</li>
<li>Ability to comply with OSHA regulations and CDC standard and transmission based precaution recommendations and to utilize proper personal protective equipment. Ability to comply with provisions of applicable S.D.S. forms.</li>
<li>Successful completion of a 180-day probationary period.</li>
</ul>
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.</div>

FPG, Clinical Improvement Specialist - Sal, FT

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.<div>
- Rework team hours of operation are Monday through Friday from 6:00 AM - 7:30 PM Central Standard Time (CST)
 
<ul><li>Schedule flexibility including nights, weekend, and holiday coverage.</li><li>This is a full time work from home position</li></ul></div>
Position Summary
Quality Specialist- Medicare D Quality role administers the quality management system to manage the review of clinical processes, documentation, and patient records. 
Interprets regulatory requirements from agencies and governing bodies to assist in the development of compliance policies and procedures. 
Additional Responsibilities to include but not limited to the following: 
<div> 
<ul><li>Learning the rework queues for each line of business</li><li>Working rework reports timely</li><li>Researching and troubleshooting failed claims</li><li>Adding and/or editing overrides in RxClaim</li><li>Logging audits and errors accurately and timely</li><li>Ability to identify trends and provide suggestions for process improvement</li><li>Researching and correcting any issues found in the overall process.</li><li>Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed.</li><li>Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations.</li><li>Solving practical problems and dealing with multiple concrete variables in standardized situations.</li><li>Performing basic mathematical calculations.</li><li>Ensuring all cases are properly closed.</li><li>Ability to interpret a variety of work instructions provided through multiple mediums.</li><li>Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards.</li></ul> 

Required Qualifications</div><div><ul><li> 
2 years of Coverage Determination &amp; Appeals experience.</li><li>MHK, RxClaim, and People Safe proficient.</li><li>Meeting quality and productivity metrics in current role.</li></ul> 

Preferred Qualifications</div><ul><li>3 years of Coverage Determination &amp; Appeals experience.</li><li>1 year of Medicare PART B experience</li><li>MHK, RxClaim, and People Safe proficient.</li><li>Meeting quality and productivity metrics in current role.</li></ul> 
Education 
High School Diploma or equivalent GED
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $42.35
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 06/17/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Quality Specialist - Medicare D Quality

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FPG, Clinical Improvement Specialist - Sal, FT

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality