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Quality Improvement Specialist, South San Francisco, CA

Health Plan of San Mateo


South San Francisco, CA

January 17, 2018


The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Quality Improvement Specialist conduct studies and analyze data to evaluate the performance of Health Plan of San Mateo in key clinical preventive and chronic care measures. Identify and implement interventions to improve performance and develop program goals and plans to meet HPSM’s internal quality goals as well as the needs of external regulatory and oversight entities.

The essential duties and responsibilities will include the following:

  • Collect and perform analysis of data related to assigned program(s) and identify opportunities for improvement and program development. Write narrative reports summarizing quality assurance and improvement findings and make recommendations based on findings.
  • Perform analysis to determine statistically significant trends in the data compared to industry standards and recognized benchmarks.
  • Monitor and ensure the validity of data, utilize Plan data systems to generate, manipulate and analyze data, as well as evaluate reports for accuracy of data.
  • Conduct root cause analysis to identify and act on contributing factors.
  • Collaborate with the reporting team to improve administrative data collection.
  • Create process documentation for program activities.
  • Establish/maintain relationships with local and community partners with the aim of promoting evidence-based care.
  • Lead and/or participate in internal and external meetings, collaboratives and coalitions related to quality improvement projects and other health education and/or cultural and linguistic related initiatives.
  • Analyze, develop, and implement improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions.
  • Participate in grant writing within the department.
  • Participate in Cultural and Linguistic Services efforts within the organization.
  • Provide physician office staff orientation to QI activities including promoting evidence-based care and familiarizing physician office staff to the support activities provided by HPSM.
  • Develop and implement intervention plan, including provider-level report cards.
  • Evaluate, monitor, and report compliance rates on a quarterly basis
  • Work directly with provider offices to increase compliance rates and practice improvement; request information from physician and other providers’ offices.
  • Work collaboratively with Health Services leadership and other clinical staff to develop and measure outcomes for other areas in Health Services such as Utilization Management and Care Coordination.


Education and Experience: Bachelor’s Degree in in Public Health, Health Education/Promotion, Epidemiology, or a related field. Master of Public Health (MPH) or other advanced degree strongly preferred. Three (3) years of experience in healthcare quality improvement, healthcare delivery systems, project management or program development and evaluation. Experience with Medi-Cal and Medicare programs/members preferred.

Knowledge of: Thorough knowledge of the principles and methods of quality improvement, research methodology, statistical analysis and report design. The concepts of managed health care. HEDIS Reporting (preferred). Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.

Ability to: Evaluate medical records and other health care data. Communicate effectively both orally and in writing. Plan, organize and lead data collection activities. Resolve simple and/or complex analytical problems. Present statistical and technical data in a clear and understandable manner utilizing appropriate visual aids. Effectively facilitate and coordinate the work of a workgroup engaged in quality improvement activities. Establish and maintain effective and cooperative working relationship with HPSM staff and others contacted in the course of the work. Maintain accurate records and confidentiality of sensitive medical information. Assume responsibility and exercise good judgment in making decisions within the scope of authority of the position. Accurately complete tasks within established times and to effectively prioritize multiple tasks and deadlines.

Starting Compensation Range: - depending on experience.

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, STD, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more. Check out our full benefits package at:

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE

Submissions without a cover letter and salary expectations may not be considered

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