CLINICAL QUALITY SPECIALIST RESUME EXAMPLE

Published: July 15, 2024 - The Clinical Quality Specialist ensures the accuracy of claims payments and develops new procedures to enhance client services. This role drafts policies and serves as a liaison to facilitate smooth communication of workflow changes across departments. Additionally, the specialist coordinates and prioritizes MPA processes, implementing quality assurance reviews to maintain high standards in compliance and efficiency.

Tips for Clinical Quality Specialist Skills and Responsibilities on a Resume

1. Clinical Quality Specialist, HealthPoint Solutions, Albany, NY

Job Summary:

  • Lead teams and system-wide efforts to improve key care processes and outcomes 
  • Work effectively across departments and with Care Sites to facilitate improvements 
  • Develop trust and effective working relationships with the quality, infection prevention, risk, process improvement, safety and other key leaders within the department and with their designated care sites 
  • Regularly communicate with the quality, infection prevention risk, process improvement and safety leaders and attend key care site committee meetings 
  • Assist care site leaders in understanding data/information regarding the organization's performance and methods for improving performance (e.g., value-based purchasing, pay for performance initiatives) 
  • Assist care site leaders in obtaining the tools, technology, and training to be able to produce the date/information they need to accelerate their ability to monitor, evaluate, improve and sustain performance excellence 
  • Identify and communicate potential risks to internal and external clients due to conflicting requirements.
  • Support/back up the CAE responsibilities


Skills on Resume:

  • Team Leadership (Soft Skills)
  • Cross-Departmental Collaboration (Soft Skills)
  • Relationship Building (Soft Skills)
  • Strategic Communication (Soft Skills)
  • Data Literacy (Hard Skills)
  • Resource Management (Hard Skills)
  • Risk Management (Hard Skills)
  • Operational Support (Hard Skills)

2. Clinical Quality Specialist, RiverCare Health, Richmond, VA

Job Summary:

  • Review claims payment for accuracy
  • Triage and provide recommendations for process improvements within the department.
  • Assist in the development of new procedures within the client services department. 
  • Draft policies that accompany these workflows within the client services team
  • Serve as liaison between departments to ensure effective communication of changes in the workflow of other departments, including claims payment
  • Create/Coordinate MPA loads for new client implementations and formulary changes that occur at Navitus FAC and P&T
  • Develop standards for all types of MPA processes
  • Prioritize MPA work with department staff.
  • Develop and perform Quality Assurance peer reviews of MPA work.
  • Utilize departmental workflow management, issue resolution and reporting tools.
  • Provide guidance to CAE's at Implementation on required elements needed to accept prior authorization information from incumbent PBM's


Skills on Resume:

  • Claims Accuracy Review (Hard Skills)
  • Process Improvement (Soft Skills)
  • Procedure Development (Hard Skills)
  • Policy Drafting (Hard Skills)
  • Interdepartmental Liaison (Soft Skills)
  • MPA Coordination (Hard Skills)
  • Standards Development (Hard Skills)
  • Quality Assurance (Hard Skills)

3. Clinical Quality Specialist, Summit Medical Center, Boise, ID

Job Summary:

  • Serve as Quality Assurance support and SME for the GDP requirement for European Logistic Service Providers for storage and shipping activities are compliant.
  • Monitor and completion of deviations, complaints, CAPA, and change control to maintain compliance in partnership with other departments.
  • Develop proactive recommendations and participate in process improvement projects.
  • Review documentation including change controls, deviations, validation documentation, SOPs, and specifications
  • Provide oversight of GDP systems completed by Service Logistic Providers and External Supply Chain.
  • Provides oversight to continuous quality system improvements and supports implementing improvements at the branch and regional offices in compliance, Deviation Management, and Change Control Programs as they impact Aspen
  • Works closely to build relationships with Logistic Service Providers quality personnel Carries out internal and external audits of Logistic Service Providers and Aspen Offices.
  • Works closely with internal cross-functional impacted areas, such as Supply Chain, Revenue Recognition, MAH to resolve open issues in a timely manner resulting from record reviews and deviation events
  • Assess temperature-controlled shipments


Skills on Resume:

  • Quality Assurance Expertise (Hard Skills)
  • Compliance Monitoring (Hard Skills)
  • Process Improvement (Soft Skills)
  • Documentation Review (Hard Skills)
  • GDP System Oversight (Hard Skills)
  • Quality System Management (Hard Skills)
  • Audit Execution (Hard Skills)
  • Cross-functional Collaboration (Soft Skills)