Clinical Quality Program Manager

Role Overview

• Serve as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business
• Lead state level quality strategy meetings and develop quality plans
• Work with the clinical intervention team to design studies to identify barriers to medical interventions
• Ensure that study methodology is sound and appropriate reporting is in place
• Develop performance improvement plans and oversee clinical quality improvement activities/projects to improve quality of care for members
• Assure compliance with corporate QI work plans
• Assure all QI activities are relevant to the needs of targeted population
• Maintain effective documentation of research programs to meet regulatory and Accreditation Standards
• Provide oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results
• Participate in and provide input to the development of new product designs for major line of business
• Oversee implementation of new initiatives
• Lead interactions with regulators or oversight entities
• Oversee quality improvement activities for the largest, most complex state programs

Requirements

• Requires a BS in health administration, nursing, or a related clinical field
• 4 years of health care quality or data analysis experience
• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred
• Experience with NCQA and HEDIS strongly preferred
• Knowledge of DMHC and/or DHCS health plan regulations strongly preferred

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• paid holidays
• Paid Time Off
• medical insurance
• dental insurance
• vision insurance
• short-term disability benefits
• long-term disability benefits
• wellness programs
• financial education resources