Quality Improvement Specialist NCQA - Denver Health Medical Plan (* Weekly Hybrid Schedule Requirement *)

Denver Health • $79K — $123K *

Denver, CO 80219Hybrid

Healthcare

Less than 5 years of experience

2 months ago

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Job Overview by Ladders

Qualifications

Bachelor's Degree in Public Health, Nursing, or related field required
4-6 years' experience in health plan quality improvement, particularly HEDIS and Medicare Stars
Certified Professional Healthcare Quality (CPHQ) certification
Green Belt certification in Six Sigma
Familiarity with Colorado Medicaid quality programs and HCPF requirements

Responsibilities

Ensure compliance with Colorado Medicaid quality programs and performance improvement projects
Support NCQA accreditation readiness and regulatory audits through documentation upkeep
Partner with teams to implement quality interventions for better health outcomes
Apply quality improvement methodologies to enhance efficiency in processes
Collect and analyze member and provider feedback for service improvement
Develop accurate dashboards and reports for stakeholders
Facilitate quality committees focused on clinical and operational initiatives

Benefits

Paid time off starting at 28 days per year, including vacation and holidays
100% paid parental leave for up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Comprehensive health, dental, and vision coverage with additional life insurance
Access to on-site fitness facilities and health programs
Free public transportation pass
Tuition reimbursement and professional development opportunities
Eligibility for Public Service Loan Forgiveness (PSLF)
Support for internal career growth through various advancement programs

Full Job Description

Managed Care Administration

Job Summary

The Quality Improvement (QI) Specialist supports the design, implementation, and evaluation of quality initiatives that enhance member outcomes, strengthen provider performance, and ensure compliance with regulatory requirements. This role is critical in advancing health plan performance across HEDIS, Medicare Stars, CAHPS, and Colorado Medicaid quality programs, while supporting NCQA accreditation and other compliance activities. The QI Specialist collaborates with cross-functional teams and external stakeholders to drive measurable improvements in clinical care, operational processes, and member experience.

Essential Functions:

Colorado Medicaid Quality Programs: Ensure compliance with HCPF quality requirements, including performance improvement projects (PIPs), External Quality Review Organization (EQRO) reporting, and population health initiatives. (20%)
NCQA & Compliance: Support National Committee for Quality Assurance: (NCQA) accreditation readiness and regulatory audits by maintaining accurate documentation and work plans. Stay current on Centers for Medicare & Medicaid Services (CMS), NCQA, and Health Care Policy and Financing (HCPF) guidelines.
(5%)
Population Health & Outcomes: Partner with care management, pharmacy, and provider networks to design and implement quality interventions that improve outcomes and reduce disparities. (10%)
Process Improvement: Apply quality improvement methodologies (e.g., PDSA, Lean, Six Sigma) to evaluate workflows, streamline processes, and enhance operational efficiency. (15%)
Member & Provider Experience: Collect and analyze feedback (CAHPS, surveys, advisory groups) to inform strategies that improve access, coordination, and satisfaction. (10%)
Data Analysis & Reporting: Develop dashboards, reports, and presentations for leadership, committees, and external stakeholders, ensuring accuracy and timeliness. (20%)
Committee Participation: Facilitate or support quality committees, workgroups, and cross-departmental projects 15focused on clinical and operational improvement. (20%)

Education:

Bachelor's Degree Public Health, Nursing, or related field required

Work Experience:

4-6 years' experience in health plan quality improvement, with direct experience in HEDIS and Stars required

Licenses:

CPHQ-Certified Professional Healthcare Quality - NAHQ - National Association for Healthcare Quality
GREENBELT-Green Belt - SSGI - Six Sigma Global Institute

Knowledge, Skills and Abilities:

Familiarity with Colorado Medicaid quality programs, HCPF requirements, and EQRO processes.
Demonstrated knowledge of NCQA accreditation standards, CMS requirements, and managed care operations.
Strong data analysis and reporting skills (Excel required; Tableau, SAS, or other tools preferred).
Excellent communication and project management skills with ability to influence cross-functional teams.
Strong Verbal and written skills

* This is a hybrid role with a weekly in-office requirement in Denver, Colorado

Shift
Days (United States of America)

Work Type
Regular

Salary
$79,400.00 - $123,100.00 / yr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health stands as a beacon of healthcare excellence in Denver, Colorado. Denver’s comprehensive healthcare system offers an array of high-paying jobs and rewarding career opportunities. This integrated network, encompassing a premier hospital, a series of community health centers, and a robust public health department, serves as the city's primary safety net institution. As a Level One Trauma Center with specialized pediatric and neonatal intensive care units, Denver Health is not only pivotal in providing critical care but also plays a significant role in medical education, being affiliated with the University of Colorado School of Medicine.

Overview of Denver Health Careers

A Diverse Range of Healthcare Roles

Denver Health careers span a wide spectrum, from clinical roles in nursing and specialized medicine to administrative and support positions. As a teaching hospital, it offers a unique environment for professional growth, blending patient care with educational opportunities.

Available Job Opportunities

High-Demand Positions

Among the highest paying and most sought-after positions at Denver Health are Psychologist, Psychiatrist, and Licensed Therapist roles. This reflects the system's comprehensive approach to mental health services alongside its medical offerings.

Nursing and Clinical Staff

Opportunities in nursing and other clinical areas offer the chance to work directly with a diverse patient population. And of course, nursing and clinical staff are supported by state-of-the-art facilities and a network of community clinics.

Administrative and Support Roles

From medical billing specialists to healthcare administrators, Denver Health provides a variety of non-clinical positions essential to the smooth operation of the healthcare system.

Qualifications and Requirements

Ensuring the Highest Standards of Care

Denver Health seeks healthcare professionals who possess the necessary skills and experience and are committed to excellence in patient care and continuous learning.

Education and Certification

For clinical positions, specific degrees, certifications, and licenses are required, reflecting the level of expertise and specialization needed to meet the healthcare needs of the Denver community.

Application Process

Steps to Joining Denver Health

The journey to a career at Denver Health begins with a straightforward application process designed to identify candidates who align with the system's values and standards of care.

Submitting Your Application

Candidates can apply through Denver Health's online job portal, where current vacancies are listed. A detailed resume and cover letter tailored to the specific position are crucial components of the application.

Interview Tips and Techniques

Standing Out as a Candidate

Succeeding in the interview requires preparation and an understanding of what Denver Health values in its staff—a dedication to patient care, teamwork, and professional integrity.

Demonstrating Your Fit

Be ready to discuss how your skills, experience, and values align with the mission of Denver Health. Prepare examples from your past work that showcase your ability to contribute positively to the healthcare system.

Training and Development Programs

Commitment to Continuous Professional Growth

Denver Health offers extensive training and development programs, supporting its staff in achieving their highest potential and ensuring the delivery of top-quality care.

Advancing Your Skills

From on-the-job training to formal education programs, employees have opportunities to enhance their clinical skills, leadership abilities, and overall knowledge of healthcare practices.

Benefits and Compensation Packages

Rewarding Your Contribution

Denver Health offers competitive benefits and compensation packages, acknowledging the hard work and dedication of its employees with rewards that reflect their value to the healthcare system.

Comprehensive Benefits

Employees enjoy a range of benefits, including health insurance, retirement plans, and paid time off, alongside opportunities for bonuses and salary advancements based on performance and experience.

Employee Testimonials and Success Stories

From Our Staff to You

Hearing directly from Denver Health employees provides insight into the supportive work environment, career advancement opportunities, and the personal satisfaction derived from making a difference in the lives of patients.

Making an Impact

Employee stories highlight the rewarding nature of work at Denver Health, where every staff member plays a critical role in providing care and improving community health.

Career Advancement Opportunities

Pathways to Professional Development

Denver Health is committed to the career advancement of its employees, offering various pathways for professional development, from leadership roles within the nursing staff to specialized medical positions and administrative leadership.

Contacts and Resources for Further Information

Navigating Your Denver Health Career Path

For more detailed information about careers, the application process, or specific job openings at Denver Health, prospective applicants are encouraged to utilize the following resources:

Denver Health Careers Page

The primary resource for current job listings, application guidelines, and comprehensive information about working at Denver Health.

Further Assistance

For specific questions not addressed on the website, potential applicants can contact Denver Health's HR department directly through the provided contact details on the careers page.

Learn more about Denver Health

Size

7,000 employees

Industry