Serves as a liaison with and oversees quality improvement activities/projects/programs for one or more states within a major line of business
Leads state level quality strategy meetings and develops a quality plan
Works with the clinical intervention team to design studies to identify barriers to medical interventions
Develops performance improvement plans and oversees clinical quality improvement activities/projects
Assures compliance with corporate QI work plans
Maintains effective documentation of research programs to meet regulatory and Accreditation Standards
Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results
Oversees quality improvement activities for the largest, most complex state programs

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) is preferred
Experience with NCQA and HEDIS strongly preferred
Knowledge of DMHC and/or DHCS health plan regulations strongly preferred

Clinical Quality Program Manager

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