CQI Specialist

ROLE SUMMARY

The Clinical Quality Improvement (CQI) Specialist is responsible for supporting the organization's Clinical Quality Improvement (CQI) Program through quality assurance activities, clinical documentation review, regulatory compliance monitoring, data analysis, and performance improvement initiatives. The position serves as a key resource in promoting clinical excellence, regulatory compliance, patient safety, and continuous quality improvement throughout the organization.

The Clinical CQI Specialist conducts patient care report (PCR) audits, investigates clinical and operational compliance concerns, develops quality metrics and reports, supports accreditation readiness efforts, and collaborates with field personnel, educators, operations leaders, and the Medical Director to improve patient outcomes and documentation quality.

This is a Exempt/Salaried position.

KEY RESPONSIBILITIES

Essential Functions / Primary Responsibilities

Clinical Quality Assurance

• Conduct focused, random, and targeted Patient Care Report (PCR) audits to evaluate documentation quality, protocol compliance, and patient care outcomes.
• Review clinical incidents, patient complaints, protocol deviations, and unusual occurrences.
• Identify opportunities for improvement and recommend corrective actions.
• Monitor compliance with Medical Director protocols, local EMS authority requirements, and organizational clinical standards.
• Participate in root cause analyses and performance improvement reviews involving adverse clinical events.

Regulatory Compliance

• Develop, implement, and complete monthly, quarterly, and annual compliance reports for local, regional, state, and organizational stakeholders.
• Monitor compliance with California EMS regulations, ICEMA requirements, Medicare documentation standards, and company policies.
• Assist in preparing for regulatory inspections, audits, accreditation reviews, and quality assessments.
• Support organizational readiness for accreditation and regulatory compliance initiatives.

Quality Improvement & Analytics

• Develop and monitor clinical, response-time, documentation, and regulatory compliance metrics.
• Utilize ESO and other reporting systems to identify trends, performance gaps, and opportunities for improvement.
• Prepare quality improvement reports, dashboards, and presentations for leadership review.
• Analyze operational and clinical data to support evidence-based decision making.
• Track corrective action plans and monitor effectiveness of implemented improvements.

Complaint & Incident Management

• Respond to, document, investigate, and follow up on complaints, incident reports, protocol exceptions, and response-time exceptions.
• Maintain documentation and records related to quality investigations.
• Collaborate with operations, training, compliance, and clinical leadership to resolve identified concerns.
• Ensure timely completion of required reporting and follow-up activities.

Clinical Education Support

• Collaborate with Clinical Education personnel to identify educational opportunities based on quality review findings.
• Assist with development of remediation plans and performance improvement initiatives.
• Provide constructive feedback to field personnel regarding documentation and protocol compliance.
• Support implementation of new clinical protocols and quality initiatives.

Certification & Credential Monitoring

• Assist in monitoring employee certifications, licenses, credentials, and regulatory requirements.
• Ensure compliance with organizational, local, regional, and state credentialing requirements.
• Support processes related to credential verification and renewal tracking.

Information Security & Confidentiality

• Maintain confidentiality of all patient, employee, quality assurance, and company information.
• Comply with HIPAA and all applicable federal, state, and local privacy regulations.
• Adhere to organizational information security and cybersecurity requirements.
• Protect the integrity and confidentiality of quality improvement activities and investigations.

Additional Responsibilities

• Demonstrates complete knowledge and compliance with company policies and procedures.
• Supports organizational goals related to quality, safety, compliance, and patient care excellence.
• Maintains professional conduct and serves as a positive representative of the organization.
• Participates in committees, projects, and special assignments as directed.
• Performs other duties as assigned by the CQI Manager, Medical Director, or Clinical Leadership.

REQUIRED QUALIFICATIONS

Minimum Qualifications

Education

• Associate degree required; Bachelor's degree preferred in EMS, Healthcare Administration, Nursing, Public Health, Quality Management, or related field.

Experience

• Minimum three (3) years of EMS, healthcare quality, clinical education, compliance, or related experience.
• Experience conducting chart reviews, audits, quality assurance activities, or clinical investigations preferred.
• Experience with ESO reporting and analytics strongly preferred.
• Experience supporting accreditation or regulatory compliance initiatives preferred.

Licensure & Certification

• Current California EMT or Paramedic certification preferred.
• Current CPR certification required.
• Valid driver's license with acceptable driving record.

Knowledge, Skills & Abilities

• Strong knowledge of EMS operations, clinical protocols, and patient care documentation.
• Knowledge of California EMS regulations and ICEMA requirements.
• Strong analytical, investigative, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to prepare professional reports and presentations.
• Strong project management and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Advanced proficiency with Microsoft Office applications.
• Ability to work independently and collaboratively across departments.
• Ability to maintain confidentiality and exercise sound professional judgment.

PHYSICAL REQUIREMENTS

The employee must be able to perform the essential functions of the position with or without reasonable accommodation.

The employee frequently:

• Ability to sit or stand for extended periods.
• Ability to utilize computers and multiple monitors for prolonged periods.
• Ability to review electronic patient care records and reporting systems for extended periods.
• Ability to occasionally travel between operational locations.
• Ability to perform all essential functions of the position with or without reasonable accommodation.

CORE COMPETENCIES

Clinical Knowledge

• Demonstrates a thorough understanding of EMS clinical protocols, patient care standards, medical terminology, documentation requirements, and quality assurance principles.

Analytical Thinking

• Collects, reviews, and interprets clinical and operational data to identify trends, root causes, performance gaps, and opportunities for improvement.

Attention to Detail

• Maintains a high degree of accuracy when conducting patient care report audits, compliance reviews, investigations, and regulatory reporting.

Problem Solving

• Evaluates complex situations objectively, identifies appropriate solutions, and develops recommendations to improve patient care, documentation quality, and regulatory compliance.

Communication

• Effectively communicates findings, recommendations, and quality improvement initiatives through written reports, presentations, and verbal interactions with employees, leadership, and stakeholders.

Collaboration

• Builds productive relationships across Clinical Services, Operations, Education, Compliance, Human Resources, Billing, and Executive Leadership to achieve organizational objectives.

Regulatory Compliance

• Maintains knowledge of applicable federal, state, local, and organizational regulations, policies, and standards governing EMS operations and patient care.

Integrity and Confidentiality

• Maintains the confidentiality of patient, employee, and organizational information while demonstrating professionalism, sound judgment, and ethical conduct.

Continuous Improvement

• Demonstrates a commitment to quality improvement, patient safety, operational excellence, and professional development.

Time and Project Management

• Effectively prioritizes competing responsibilities, manages deadlines, and completes assignments accurately and efficiently.

REPORTING RELATIONSHIP

Reports directly to the Director of Clinical Services or Regional Clinical Director.

WORK ENVIRONMENT

• The Clinical CQI Specialist primarily works in a professional office environment utilizing computers, quality management software, electronic patient care reporting systems, and data analytics platforms. Duties require extensive review of electronic patient care records, regulatory documentation, reports, and quality metrics.
• The position may require occasional travel to operational locations, stations, training facilities, hospitals, regulatory meetings, and corporate offices. The employee may occasionally be exposed to operational environments, including ambulance stations, training environments, and healthcare facilities.
• Work may occasionally require flexibility outside of normal business hours to support investigations, regulatory reporting requirements, quality reviews, accreditation activities, or organizational needs.
• The employee must be able to maintain strict confidentiality and exercise sound professional judgment when handling sensitive clinical, patient, employee, and organizational information.