Quality Specialist 1 - St. Luke's Health Plan

St. Luke's Health System; Boise (ID); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

On-site massages

Employee Assistance Program

Wellness tools

Career development

Job summary

St. Luke’s Health System is seeking a Quality Measure Specialist to advance quality performance and regulatory excellence.

You will drive HEDIS, NCQA, CMS Star Ratings initiatives and validate data from EHRs and care management systems to ensure accurate reporting. You’ll collaborate with providers, vendors, and internal teams to close data gaps, maintain audit-ready docs, and support organizational quality goals.

Qualifications

• Bachelor’s degree or experience in lieu of degree.
• Experience with quality reporting (HEDIS, NCQA, CMS Star Ratings) is preferred.
• Ability to review and abstract clinical data from electronic health records.
• Strong collaboration with providers, vendors, and internal stakeholders.

Responsibilities

• Drive quality measurement and improvement efforts by supporting HEDIS, NCQA, CMS Star Ratings, and other regulatory/performance initiatives.
• Review, abstract, and validate clinical data from electronic health records, medical records, and care management systems to ensure accurate reporting.
• Identify documentation gaps, data discrepancies, and improvement opportunities that affect quality performance and audits.
• Partner with providers, vendors, and internal stakeholders to gather information and resolve data issues.
• Coordinate quality projects, action plans, reporting activities, and deliverables.
• Maintain audit-ready documentation and reporting logs for regulatory reviews and audits.
• Monitor evolving quality measurement requirements and translate changes into operational improvements.
• Contribute to initiatives that enhance measurement accuracy and data reliability.

Skills

Quality measurement

Regulatory compliance

Data abstraction

Cross-functional collaboration

Education

Bachelor’s degree or experience in lieu of degree

Tools

EHR systems

Quality reporting tools

Job description

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.

As aQuality Measure Specialist, you'll play a critical role in advancing quality performance, regulatory excellence, and member experience through the successful execution of HEDIS, NCQA, CMS Star Ratings, and other key quality initiatives.

What you can Expect

As part of our Quality team, you'll help ensure the accuracy, integrity, and impact of the data that drives healthcare quality improvement. Working across clinical, operational, and vendor partners, you'll support programs that improve member outcomes, strengthen regulatory compliance, and increase organizational performance.

In this role, you will have the opportunity to:

• Drive quality measurement and improvement efforts by supporting HEDIS, NCQA, CMS Star Ratings, and other regulatory and performance initiatives.
• Review, abstract, and validate clinical data from electronic health records, medical records, and care management systems to ensure accurate and compliant quality reporting.
• Identify documentation gaps, data discrepancies, and improvement opportunities that impact quality performance, audit readiness, and measure outcomes.
• Partner with providers, vendors, and internal stakeholders to gather information, resolve data issues, and strengthen documentation and reporting practices.
• Coordinate quality projects, action plans, reporting activities, and operational deliverables that support organizational quality goals.
• Maintain audit-ready documentation, validation records, supporting evidence, and reporting logs for regulatory reviews, compliance audits, and delegated oversight activities.
• Monitor evolving quality measurement requirements and technical specifications, helping teams translate changes into operational improvements and sustainable processes.
• Contribute to initiatives that enhance measurement accuracy, data integrity, reporting reliability, and overall quality performance.

Requirements

• Education: Bachelor’s degree or experience in lieu of degree
  

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.

As aQuality Measure Specialist, you'll play a critical role in advancing quality performance, regulatory excellence, and member experience through the successful execution of HEDIS, NCQA, CMS Star Ratings, and other key quality initiatives.

What you can Expect

As part of our Quality team, you'll help ensure the accuracy, integrity, and impact of the data that drives healthcare quality improvement. Working across clinical, operational, and vendor partners, you'll support programs that improve member outcomes, strengthen regulatory compliance, and increase organizational performance.

In this role, you will have the opportunity to:

• Drive quality measurement and improvement efforts by supporting HEDIS, NCQA, CMS Star Ratings, and other regulatory and performance initiatives.
• Review, abstract, and validate clinical data from electronic health records, medical records, and care management systems to ensure accurate and compliant quality reporting.
• Identify documentation gaps, data discrepancies, and improvement opportunities that impact quality performance, audit readiness, and measure outcomes.
• Partner with providers, vendors, and internal stakeholders to gather information, resolve data issues, and strengthen documentation and reporting practices.
• Coordinate quality projects, action plans, reporting activities, and operational deliverables that support organizational quality goals.
• Maintain audit-ready documentation, validation records, supporting evidence, and reporting logs for regulatory reviews, compliance audits, and delegated oversight activities.
• Monitor evolving quality measurement requirements and technical specifications, helping teams translate changes into operational improvements and sustainable processes.
• Contribute to initiatives that enhance measurement accuracy, data integrity, reporting reliability, and overall quality performance.

Requirements

• Education: Bachelor’s degree or experience in lieu of degree
  

What's in it for you:

At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.