Quality Management Specialist

About the Company

Medical Review Institute of America was established in 1983 and operates as a clinically focused, technology-enabled utilization management organization. The company provides clinical review services, regulatory support, and practical insights to healthcare organizations.

Its culture is built around strong clinical expertise and a purpose-driven approach, with an emphasis on people and performance.

What the Role Involves

The Quality Management Specialist will work with leadership to design and roll out quality management processes, drive continuous improvement efforts, and support projects that help the organization meet internal, accreditation, and regulatory standards. The role requires using data, trend analysis, and structured improvement methods to lower variation, reduce errors and adverse events, and strengthen overall performance.

Key Duties

This position includes reviewing existing policies, procedures, and workflows to spot gaps and recommend updates that align with current regulatory and accreditation expectations. The specialist will assess process performance, study trends and stability, and identify risks or shortfalls against defined metrics.

They will also lead and support formal improvement efforts using approaches such as Lean, Six Sigma, or DMAIC, manage quality improvement projects from problem definition through validation, and oversee corrective and preventive action plans with documented root cause analysis and follow-through. In addition, the role involves acting as a point of contact between clients and the quality management team when needed.

Other responsibilities include supporting the creation and revision of quality policies, performing internal back-end audits, collaborating with other departments, testing software changes, conducting root cause analyses, building control mechanisms to sustain improvements, and measuring the impact of quality initiatives. The specialist will also help manage the Quality Management System, support complaint review activities, prepare materials and presentations for the Quality Management Committee, track action items, and assist with audits, client remediation efforts, SLA monitoring, and other assigned work.

Work Setting

This is a remote, work-from-home position. The job requires the ability to sit for long periods and regularly use a computer, telephone, and standard office equipment.

Compensation and Benefits

The company offers a competitive pay package along with healthcare, vision, and dental coverage. Additional benefits include a generous 401(k) match, paid vacation, personal time, holidays, training and growth opportunities, and a team-oriented environment with events and prizes throughout the year.

Requirements

Candidates should have strong experience using structured quality improvement methods such as Lean, Six Sigma, or DMAIC. A Six Sigma Green Belt or similar certification is preferred. The role also calls for excellent client service, strong analytical and critical thinking ability, effective verbal and written communication, high attention to detail, solid organization, comfort working under pressure, and the ability to manage several priorities while maintaining a flexible schedule.

Applicants should understand managed care and utilization review accreditation standards, including URAC and NCQA, along with multi-state regulatory requirements. Proficiency with Microsoft Word, intermediate Microsoft Excel, PowerPoint, and Power BI is expected, and candidates must be able to work with objectivity and confidentiality. At least 5 years of experience in a quality management role is required. Experience in healthcare, health insurance, or managed care quality improvement is preferred, along with experience training small groups or individuals and research experience.

Education

A high school diploma is required. A bachelor’s degree is preferred, or equivalent practical experience may be considered.

Compliance and Screening

The employer is a drug-free workplace. Selected candidates must complete a background check before starting and a drug screen on the first day of employment. All employees are expected to follow HIPAA rules and company policies for the confidentiality, privacy, and security of sensitive health information.

Equal Opportunity

All qualified applicants are considered without discrimination based on race, color, religion, sex, age, national origin, veteran status, disability, sexual orientation, gender identity or expression, marital status, genetic information, or any other protected characteristic.

California Residents

For California applicants, the employer may collect sensitive personal information such as names, contact details, Social Security numbers, signatures, online identifiers, IP addresses, driver’s license or state ID numbers, and passport numbers. Applicants may request access to their data or ask for corrections, deletion, or edits by contacting the employer’s HR team.