About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the world’s first Lab Insights company, transforming laboratory data into actionable insights that improve healthcare affordability and outcomes. Serving 44+ million members nationwide, Avalon partners with health plans to manage lab benefits, reduce costs by 10–20%, and enable earlier disease detection through real-time digitized lab analytics.

Backed by Francisco Partners, Avalon is a fast-growing, mission-driven organization pioneering value-based care through advanced lab insights, proprietary analytics, and innovative clinical support.

Learn more: www.avalonhcs.com

Position Overview:

Avalon is seeking a Clinical Quality Improvement Specialist to develop, implement, and manage quality improvement initiatives that align with organizational and client health plan goals. This position plays a key role in establishing quality metrics, conducting root cause analyses, ensuring compliance with NCQA standards, and managing delegation oversight and clinical studies.

Key Responsibilities:

Maintain and manage departmental documents in PowerDMS, including version control, naming conventions, and publication.
Develop and update the annual QI Work Plan, monitor associated metrics, and evaluate annual performance.
Analyze trended quality metrics, identify performance variations, and coordinate corrective actions across departments.
Lead the creation and monitoring of internal and external quality reports and audits.
Support client health plan delegation oversight and internal audit processes.
Prepare agendas and materials for Quality Improvement Committee meetings.
Monitor and implement necessary changes in NCQA accreditation standards.
Act as project manager for NCQA certification and client-specific accreditation requirements.
Support new client health plan onboarding, including medical policy integration and delegation assessments.
Manage and evaluate clinical quality studies, including ROI analysis, national benchmarks, and outcomes measurement.
Coordinate with vendors like Advanced Medical Reviews and interact with client stakeholders to ensure compliance and quality.

Required Qualifications:

3–5 years of healthcare quality improvement experience in a managed care or vendor relationship environment.
Active, unrestricted RN license (BSN preferred).
Strong knowledge of NCQA accreditation, medical policies, clinical coding, and health plan claims processes.
Exceptional written/verbal communication and presentation skills.
Advanced proficiency in Microsoft Office Suite (Excel, PowerPoint, Word).
Strong project management, organizational, and problem-solving abilities.

Preferred Qualifications:

Certified Medical Billing and Coding
Experience with lab/genetic test management
Certifications in Healthcare Quality, Project Management, or Six Sigma

Why Join Avalon?

Be part of a mission-driven, high-growth organization transforming lab-driven care.
Work with a collaborative, remote team and help shape a new healthcare market.
Enjoy a flexible remote role with quarterly in-person collaboration in Tampa, FL.
Contribute to groundbreaking clinical innovations that improve outcomes and affordability.

APPLY

Clinical Quality Improvement Specialist