QA QI Specialist

Job Title: Quality Assurance and Quality Improvement (QAQI) Specialist

Department: Non-Clinical

Reports to: Senior Program Director

FLSA Status: Non-Exempt

Prepared by: Human Resources

Last Modified: 04/25/2024, 02/18/2026, 05/11/2026

Summary

QAQI Specialist provides oversight of programmatic and interventional activities in accordance with contractual, regulatory requirements. QAQI professionals are ultimately responsible for guaranteeing the quality of products and services. Their day-to-day work involves careful inspections and the enforcement of quality standards from monitoring clinical and operational performance, analyzing data and outcomes, and conducting audits and chart reviews.

General Accountabilities

• Interpret and comply with quality assurance standards.
• Ensure ongoing abidance by industry regulatory and quality requirements.
• Documenting and reporting product or service quality levels.
• Achieve a strong working knowledge of all company policies and procedures.
• Collaborate with clinical, administrative, and leadership teams to improve workflows, patient outcomes, and service delivery.
• Complete health risk assessments as necessary.
• Monitor IPA data reporting requirements and upload all data to various IPA and payor data portals.
• Monitor all payer portals and respond to all insurance-driven requests for data, working with the clinical team as necessary to complete data requests.
• Conduct random chart audits for the clinical team.
• Data entry, Answer, refer and/or follow-up via telephone, fax, email and mail with patient questions related to the program and specific needs of the patients. Triage to the appropriate Care team.
• Conduct random chart audits for the clinical team.
• Maintains accurate documentation in google sheets or tracking logs.
• Performs routine specialized procedures, such as setting up the iHealth products for the patients under established protocols.
• Manages clinic inventories and medical supplies.
• Educates and advises patients on specific medical issues within established parameters to include obtaining prescription information.
• Directs patient flow following provider schedules/patient appointments.
• Coordinates routine office activities and administrative functions to support clinic activities.
• Assist with special projects, community health initiatives, and organizational improvement efforts aligned with UCHC.
• Other duties assigned by the Senior Program Director.