Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Quality Specialist plays a critical role in advancing clinical excellence and operational performance across multiple physician practice sites. This individual is responsible for developing, implementing, and monitoring quality improvement initiatives that align with regulatory standards and organizational goals. With a strong focus on enhancing patient outcomes, safety, and satisfaction, the Quality Specialist serves as a strategic partner to clinical and operational leaders, driving continuous improvement and fostering a culture of quality.

In this role and reporting to the VP of Quality Improvement and Provider Performance, the Quality Specialist leads quality improvement and patient safety initiatives, acting as a thought partner and subject matter expert across all practice sites. They collaborate with cross-functional teams and task forces to organize and deploy quality campaigns, while also developing and tracking key clinical quality metrics such as HEDIS, Medicare Stars, and value-based care performance indicators. The role includes facilitating clinical audits, ensuring compliance with federal, state, and payer standards, and staying current with NCQA policy and data specification changes.

The Quality Specialist works closely with providers, care teams, and operational leaders to implement evidence-based practices and reduce care variation. They coordinate training and education programs on quality compliance and risk management, and support external audits, accreditation surveys (e.g., Joint Commission, NCQA), and regulatory reviews. A key responsibility includes analyzing data to identify trends and opportunities for improvement and preparing reports and presentations for internal quality councils and leadership meetings.

Additional responsibilities include managing grievance and adverse event triage, response, and tracking, as well as overseeing policy and procedure development, updates, and education. The Quality Specialist ensures end-to-end evaluation of workflows to close quality gaps, including accurate claims submissions and CPT CAT II code processing. This role serves as a vital liaison between clinical leadership, operations, and compliance teams, ensuring alignment and accountability across the organization’s quality initiatives.

Skills Required:

• Strong knowledge of healthcare quality standards, including HEDIS, Medicare Stars, NCQA, and value-based care.

• Proficiency in data analysis, interpretation, and reporting using tools such as Excel, PowerBI, or similar platforms.

• Experience with clinical audits, regulatory compliance, and accreditation processes (e.g., Joint Commission, NCQA).

• Excellent written and verbal communication skills, including the ability to prepare and present reports to leadership.

• Project management skills with the ability to lead initiatives across multiple sites and teams.

• Familiarity with CPT CAT II coding and claims submission processes.

• Ability to develop and deliver training and education programs for clinical and operational staff.

Key Behaviors:

• Proactive Problem-Solving
  Demonstrates a solutions-oriented mindset in addressing quality and safety challenges.

• Collaborative Engagement
  Works effectively with cross-functional teams, including clinical, operational, and compliance stakeholders.

• Detail Orientation
  Maintains a high level of accuracy in data tracking, reporting, and documentation.

• Adaptability
  Responds with agility and resilience to changing regulatory requirements and organizational priorities.

• Integrity
  Acts with accountability and discretion when managing sensitive information and quality-related issues.

• Continuous Improvement
  Champions a culture of learning, innovation, and patient-centered care.

Competencies:

• Quality Improvement & Patient Safety: Deep understanding of quality frameworks and ability to lead initiatives that improve clinical outcomes and reduce care variation.

• Regulatory & Compliance Knowledge: Expertise in healthcare regulations and accreditation standards, ensuring organizational readiness and compliance.

• Analytical Thinking: Ability to synthesize complex data to identify trends, gaps, and opportunities for improvement.

• Communication & Influence: Skilled in communicating complex information clearly and persuasively to diverse audiences.

• Leadership & Collaboration: Demonstrated ability to lead cross-functional teams and influence without direct authority.

• Operational Excellence: Strong process orientation with a focus on workflow optimization and policy management.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.