The Manager of Clinical Quality is responsible for managing the day-to-day activities of one or more clinical quality program components which may be related to HEDIS reporting, NCQA accreditation and/or other quality assurance related activities.

This is a remote position / work from home.

How you will make an impact:

Implements and evaluates current processes including operational statistics, service standards and process improvement initiatives.

Provides oversight in the planning, implementation, and coordination of health care audits to ensure high-quality, cost-effective care.

Participates in internal and external quality review activities.

Manages and oversees quality assurance activities, which may include, but is not limited to:

Managing the production, analysis, and submission of the annual HEDIS report

Overseeing community health promotion and disease management initiatives in each state in the region

Coordinating audit activities with other regions; managing achievement and maintenance of NCQA accreditation

Scheduling all information for surveys, conducting mock audits, and providing consultation to business units and team leads as regards NCQA standard issues.

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requirements:

BS in nursing or a health care related field and minimum of 3 years of managed care experience which includes a minimum of 2 years supervisory experience; or any combination of education and experience, which would provide an equivalent background.

Assets and preferred qualifications:

Experience in program development

Knowledge of the quality process and QI techniques.

MS in nursing or related clinical field

CPHQ