Clinical Quality Program Manager
WellSky
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Facilitate activities related to performance measurement and outcomes, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices
- Generate and validate reports to monitor performance across health plan contracts, ensuring accuracy and alignment with requirements
- Conduct regular audits of UM decisions, case documentation, turnaround times, and adherence to other CMS and NCQA requirements
- Understand how the UM Program is driven by the NCQA UM standards to ensure UM Program meets all NCQA requirements for accreditation
- Prepare and lead committee meetings on a monthly and quarterly basis, driven by NCQA requirements
- Prepare detailed quality reports, identify and analyze trends, and present findings to leadership with actionable recommendations
- Support implementing corrective action plans when scoring variances occur
- Support quality improvement project initiatives
- Prepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings
- Perform other job duties as assigned
Requirements
- At least 4-6 years relevant work experience
- Experience leading quality improvement projects and committee work
- Bachelor's Degree or equivalent work experience
- Active, unrestricted license: RN, PT, OT or SLP, with a bachelor’s degree in a related field or a combination of education and experience that includes pertinent clinical experience and advanced working knowledge of CMS standards and guidelines
- At minimum, 1-2 years of working knowledge of NCQA UM accreditation standards
- Must be able to prioritize, plan and handle multiple tasks and demands simultaneously, with competing deadlines
- Excellent in manipulating and sorting data for analytics and reporting
- Prior experience owning client compliance SLAs and ensuring success in meeting SLA requirements.
Benefits
- Excellent medical, dental, and vision benefits
- Mental health benefits through TelaDoc
- Prescription drug coverage
- Generous paid time off, plus 13 paid holidays
- Paid parental leave
- 100% vested 401(K) retirement plans
- Educational assistance up to $2500 per year
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
performance measurementreport generationdata analyticsquality improvementauditingcorrective action planscompliance managementclinical experienceNCQA UM standardsCMS standards
Soft skills
leadershiporganizational skillscommunicationprioritizationplanningmultitaskinganalytical thinkingpresentation skills
Certifications
RNPTOTSLP