Quality Improvement Process Specialist
DataStaff, Inc. is currently seeking a Quality Improvement Process Specialist for a contract opportunity with one of our direct clients in Raleigh, NC.
Our client works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state, and federal entities; and other community partners vested in improving the health and safety of all North Carolinians by providing essential human services. They are one of the largest, most complex agencies in the state, with about 17,000 employees.
Our client is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. Our client manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual/developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, our client ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.
*This contract position requires you to report onsite in Raleigh 8 times per month.
Job Description:
Develops, assesses, and improves assigned Quality Improvement (QI) processes. Translates applicable requirements and quality strategy priorities into practical workflow. Builds QI capability among health plans and internal staff. Delivers actionable strategic feedback to Quality Management leadership. Works independently, collaborates effectively, and promptly escalates material risks. Reports to the Senior Quality Manager for deliverables.
Job responsibilities:
- Process ownership and alignment - Designs, documents, implements, measures, and refines assigned end-to-end processes; specifies ownership, controls, handoffs, approval points, and measurable links to NC Medicaid strategic quality goals.
- Remediation and Quality Assurance (QA) - Identifies defects, delays, variation, or weak controls. Uses root-cause analysis and structured improvement methods to develop corrective recommendations and verify whether approved changes work.
- Six Sigma and QI expertise. Serves as a process-improvement subject-matter expert. Applies DMAIC, process mapping, measurement, and other fit-for-purpose methods. Coaches without imposing an unnecessarily complex methodology.
- Regulatory and policy support. Works with authorized subject-matter experts to translate applicable federal regulations, contracts, and approved policies into operational oversight controls. Identifies ambiguity or gaps for decision-making on state policy.
- Standard Operating Procedures (SOPs) and Standard Operating Guidelines (SOGs). Drafts and maintains internal and external standard operating procedures SOPs and SOGs. Designs templates, process maps, and version-controlled job aids for state review and approval.
- Training and stakeholder development. Delivers training and technical assistance to health plans and internal teams. Cultivates effective relationships with health plan staff and clinical experts as well as policy, analytics, operations, contractors, and leadership staff.
- Leadership feedback and escalation. Provides concise, evidence-based briefings on progress, risks, root causes, options, and recommendations. Independently prioritizes work and escalates material issues through established channels.
- Delivery-system awareness. Ability to interpret and tailor quality improvement work to Medicaid Managed Care and Medicaid Direct populations, entities, processes, and accountability structures.
Skills:
- Previous leadership experience in quality improvement
- Advanced analytical capabilities, including the ability to interpret complex data sets and make data-driven strategic decisions.
- Excellent communication skills with the ability to engage internal and external stakeholders at various organizational levels
- Proficient in Microsoft Office Suite, especially Excel, PowerPoint, and Word
- Applied knowledge and experience with data analysis tools and software
Required Qualifications:
- Master’s Degree in Public Health, Business Administration, Healthcare Administration, or a related field.
- Minimum of 3-5 years of professional experience with Medicaid and/or Managed Care Organizations working in Quality Improvement
- Proven project management skills with the ability to manage multiple deliverables and meet strict timelines
Preferred Qualifications:
- CPHQ or PMP Certification
- Six Sigma Green Belt certification
This opportunity is available as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.