Clinical Quality Manager - Remote

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together The Quality Management Manager will monitor and support the health plan quality improvement initiatives with particular emphasis on HEDIS, NCQA, and State Performance measures. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. You’ll enjoy the flexibility to work remotely

• if you are located in Pennsylvania as you take on some tough challenges. This position is remote with up to 10%25 travel reputed company the PA market.

Primary Responsibilities: reputed company the implementation of plan’s quality improvement program (QAPI) Work to coordinate the work with the clinical, operations, and network teams to improve HEDIS and NCQA performance and to reputed company gaps in care Manage Quality work plan programs and activities Collaborate across local and national business segments to reputed company goals and targets reputed company and maintain positive relationships with external state organizations reputed company the scope of Quality Management Continuously monitor HEDIS, NCQA, and state performance measure results and adjust programs to ensure targeted goals Support Performance Improvement Projects, accreditation, and regulatory audits as needed reputed company and mentor quality department staff reputed company quality quarterly review meetings with state partners Serve as panelist for grievance and appeal hearings You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications: RN License in the state of Pennsylvania 2+ years of experience with HEDIS and NCQA - this includes PIP and quality improvement project experience 1+ years of leadership/management experience (e.g., Review work of others, serve as an expert in their field, serve as a mentor and leader, reputed company functional or reputed company teams or projects, motivate and reputed company team members) Experience with reputed company audit organizations such as External Quality Review Organizations (EQROs) Experience with managed care and insurance industry Experience in writing reports and analyzing performance data Experience creating detailed reports and project management reputed company in PA Preferred Qualifications: 2+ years demonstrated Management experience with responsibility for team performance management Quality improvement experience reputed company a health plan- CPHQ Certification Experience with reputed company (working with pivot tables) and creating PPT presentations reputed company experience Clinical experience / background Change management experience and demonstrated skills Proven ability to reputed company independent reputed company Proven ability to complete various deliverables utilizing scholarly writing and AI technology *reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $91,700 - $163,700 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply To This Job