Quality Manager

Who we need:

Acentra Health is seeking a Quality Manager to join our team. As the Quality Manager, you will be responsible for developing, implementing, and monitoring quality and performance improvement activities and clinical outcomes for our organization. You will play a key role in supporting both medical and behavioral health departments in delivering high-quality care.

What you'll do:

• Lead and facilitate all Quality and Performance Improvement (QPI) activities across the organization
• Provide coaching and support to managers and staff regarding QPI
• Ensure the implementation of key performance indicators and maintain systems for tracking, reporting, and improving performance
• Assist in developing benchmarks for quality measures and outcomes
• Facilitate access to relevant policies, procedures, and resources for staff
• Promote awareness of customer requirements throughout the organization
• Participate in existing CQI activities, quality/outcome studies, and program development
• Lead local quality improvement committee and participate in clinical practice oversight committee
• Support quality of care reviews and assist in resolving member grievances or complaints
• Monitor and ensure staff have appropriate credentials and training
• Conduct audits of utilization and case management cases
• Monitor and report on quality indicators to identify opportunities for improvement
• Develop and maintain Quality Improvement Processes (QIPs) in alignment with regulatory requirements
• Evaluate program effectiveness and document quality metrics
• Review member satisfaction surveys and compare to performance indicators
• Report critical incidents to corporate compliance and assist with action plans
• Execute CQI plans to meet business requirements
• Participate in preparing quarterly and annual quality reports for clients
• Identify patterns and trends in clinical case and utilization management performance
• Maintain the Department's Quality Management Plan and Program Description
• Coordinate with Subject Matter Experts (SMEs) in developing clinical solutions
• Support commercial implementations and RFP/proposal processes for clients

Requirements:

• Active unrestricted nursing license, or other applicable State and/or Compact State clinical licensure
• Bachelor's degree in nursing
• Formal training or certification in quality desired (CPHQ, ISO, Six Sigma)
• Quality management experience in a health-related field
• Solutioning and problem-solving experience in utilization and case management programs
• Minimum of 2 years case management experience
• Minimum of 1 year utilization management experience (preferred)
• Experience with commercial health plans and/or clinical programs (preferred)
• Knowledge of performance improvement strategies, principles, methodologies, techniques, and data analysis
• Ability to provide leadership, maintain confidentiality, and meet deadlines
• In-depth knowledge of CQI tools, methods, and techniques such as Six Sigma
• Excellent grasp and understanding of Statistical Process Control (SPC)
• Knowledge of URAC, NCQA, and/or ISO background (a plus)
• Strong analytical skills and ability to evaluate data objectively
• Excellent communication, organizational, presentation, and interpersonal skills
• Proficient in MS Office applications and internet/web navigation

Requirements

Qualifications:

• Active unrestricted nursing license, or other applicable State and/or Compact State clinical licensure required
• Bachelor's degree in nursing required
• Formal training or certification in quality desired (CPHQ, ISO, Six Sigma)
• Quality management experience in a health-related field required
• Solutioning and problem-solving experience in utilization and case management programs required
• Minimum of 2 years case management experience required
• Minimum of 1 year utilization management experience preferred
• Experience with commercial health plans and/or clinical programs preferred

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.  

Compensation

The pay range for this position is $90,000-110,000

“Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”