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The Senior Quality Improvement Specialist leads and manages complex health service improvement initiatives, ensuring compliance with regulatory standards. This role involves program assessment, vendor oversight, development of performance measures, and collaboration across departments to improve healthcare outcomes and member satisfaction.

The Case Manager evaluates and coordinates care for members with significant mental and behavioral health needs. They assess member needs, develop care plans, educate members and families about available services, and facilitate access to community resources. Frequent home visits are required to assess member condition and facilitate education on treatment options and benefits. The role also includes providing feedback for improving service delivery and compliance with guidelines.

Identify, negotiate, and manage high performing provider and vendor partnerships. Lead financial analyses and operational reporting for vendor and provider agreements. Develop and initiate corrective action plans for partnerships. Collaborate with internal teams and lead meetings to review agreement performance data and strategy.