**Role Overview:** The Quality Performance Specialist – Clinical supports the Quality Management (QM) team by leading and coordinating clinical quality reviews of member concerns and medical records, ensuring adherence to established standards of care. This role plays a key part in quality improvement initiatives, accreditation readiness, and annual medical record reviews, including Healthcare Effectiveness Data and Information Set (HEDIS) and Clinical Practice Guidelines.

**Work Arrangement:**

+ Remote - Fully remote position; may be performed from any location within the United States
+ Availability required during Eastern Standard Time (EST) hours
+ Reliable high‑speed internet required (minimum 50 Mbps download / 5 Mbps upload)
+ Associates residing in states where reimbursement is required by contract, law, or regulation may submit eligible expenses for reimbursement

**Responsibilities:**

+ Lead quality-of-care (QOC) reviews, including...