Quality Management Specialist

Quality Management Analyst Overview:Location: Hybrid - onsite Tuesday, Wednesday, and ThursdayThe Quality Management Analyst is responsible for the oversight, administration, development, and strategic planning of quality management initiatives to ensure compliance with regulatory and legislative requirements. This role plays a critical part in evaluating program effectiveness, identifying gaps, and driving process improvements across the organization.Key Responsibilities:Develop and execute program evaluation plans; analyze outcomes and report on progress toward organizational goals Identify barriers to performance and provide evidence-based recommendations for improvement Analyze credentialing processes"”particularly high-risk, high-volume, or problem-prone areas"”to mitigate risk and enhance provider satisfaction Support Credentialing Services by managing and optimizing the credentialing database, ensuring data integrity, and producing routine and ad hoc reports Review and investigate potential credentialing non-compliance or discrimination concerns Collaborate with internal and external stakeholders to enhance processes and ensure quality and compliance standards are met Analyze existing databases to ensure data accuracy, reliability, and relevance Develop detailed specifications for reports, business intelligence tools, and audit processes Research and address quality issues identified through regulatory agencies, executive inquiries, consent orders, and other sources Design and maintain audit tools, including those for ad hoc reviews Analyze audit findings, identify process gaps, and recommend corrective action plans with follow-up tracking Facilitate development and review of Credentialing Program Descriptions and Statements of Effectiveness Maintain and update desk procedures and process documentation Conduct gap analyses between regulatory requirements and internal policies Qualifications:Bachelor's degree required; clinical license or equivalent experience preferred RN or Master's in Public Health (MPH) strongly preferred Experience, Knowledge, & Skills:Minimum of 5 years of experience in a managed care environment Strong knowledge of NCQA accreditation standards, CMS guidelines, and state/federal regulations Proven experience in data analysis, reporting, and project coordination Excellent written and verbal communication skills, with strong emphasis on report writing Strong organizational, analytical, and problem-solving abilities Ability to work independently, manage priorities, and adapt in a fast-paced environment Demonstrated ability to collaborate effectively with stakeholders at all levels Experience serving as a team facilitator and internal consultant

Created: 2026-05-08