Healthcare Quality Management Specialist

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Medical Review Institute of America, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1983

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS • Data

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

📋 Description

• partner with key members of leadership for the design and implementation of Quality Management procedures • ongoing improvement efforts, and other team projects with the aim of achieving organizational, accreditation, and regulatory requirements • Review and analyze current processes related to the application and implementation of policies, procedures, and practices • provide leadership with recommendations for updates to comply with the current regulatory and accreditation requirements • Identify gaps in efficient process workflow and suggests steps for quality process improvement • Measure process performance using valid and accurate methods; analyze trends, variation, and process stability to determine if defined performance metrics are met and identify areas of risk • lead and support structured quality improvement initiatives (e.g. DMAIC or equivalent) • Manage and lead Quality Improvement Projects (QIPs) • Manage and ensure execution of CAPAs, including documented root cause analysis, defined success metrics, implementation tracking, and post-implementation validation demonstrating sustained improvement in coordination with the Clinical Quality, Compliance, and Operations leaders • Serve as liaison between clients and MRIoA’s quality management department as needed • Assist leadership in establishing and reporting quality metrics

🎯 Requirements

• Minimum of 5 years’ experience in a quality management role • Demonstrated experience applying structured quality improvement methodologies (e.g., Lean, Six Sigma, DMAIC) required • Working knowledge of managed care and utilization review accreditation standards, including URAC and NCQA, and multi-state regulatory requirements • Six Sigma Green Belt or equivalent certification preferred • Exceptional customer service skills • Exceptional analytical and critical thinking skills • Excellent oral and written communication skills and interpersonal skills • Exceptional orientation to detail • Excellent organizational skills • Ability to work under pressure and meet deadlines while managing multiple high priorities and supporting a flexible schedule • Knowledge and understanding of the Company’s clients, products, departments, and workflows • Personal computer literacy and competency in use of Microsoft Word, Microsoft Excel (intermediate skill), Power Point and PowerBI • Ability to maintain a high level of objectivity and confidentiality • Experience in quality improvement activities within a healthcare, health insurance and/or managed care organization preferred • Experience in supplying small group and individual training preferred • Experience in research beneficial and preferred

🏖️ Benefits

• healthcare, vision and dental insurance • a generous 401k match • paid vacation • personal time • holidays • Growth and training opportunities • A team atmosphere with fun events and prizes scheduled throughout the year