Clinical Quality Manager

Job Summary

A company is looking for a Manager, Clinical Quality.

Key Responsibilities

• Manage and oversee quality assurance activities related to clinical UM and A&G staff for health plan customers
• Execute the Quality Improvement Program and support compliance audits for health management programs
• Compile, analyze data, and prepare reports related to clinical quality metrics and workflows

Required Qualifications

• Bachelor's degree in nursing is required; Master's degree or CPHQ preferred
• Ten years of progressive experience in healthcare administration or clinical quality
• Five years of management experience in Health Management focused on Quality and Utilization Management
• Strong knowledge of CMS regulations for Medicare Advantage and Utilization Management
• Ability to manage onshore and offshore teams across multiple locations and time zones