Manager Clinical Quality

Job Description Summary

The Manager Quality plays a vital role in the organization's overall quality strategy. The Manager Quality is responsible for leading and optimizing the Quality Assurance function, with a focus on care gap closure, patient engagement, and HEDIS/Stars performance. This role partners closely with the payor quality teams to achieve quality performance goals. The Quality Manager collaborates cross-functionally with quality leadership, analytics, and regional teams to foster a culture of continuous improvement through collaboration, communication, and leadership.

How will you make an impact & Requirements

• Responsibilities

• Lead the Quality Assurance team in executing care gap closure strategies through medical record review, CPTII coding or supplemental data submission, and proactive patient outreach

• Monitor team productivity and patient engagement using operational performance metrics to optimize quality outcomes and efficiency

• Serve as a liaison between centralized and regional quality teams to provide feedback and share best practices

• Maintain an in-depth knowledge of current HEDIS/Stars metrics and benchmarking standards and leads education and training to the Quality Assurance team.

• Evaluate payor scorecards for accuracy and create comparative analyses comparing payor and internal data to evaluate program performance and identify improvement opportunities.

• Coordinate regular engagement between MPG and payor quality teams to review performance, coordinate on joint initiatives, and resolve data discrepancies.

• Achieve quarterly and annual quality targets as outlined in contracts and communications (i.e. Preventative screenings, care coordination, and chronic disease HEDIS metrics).

• Supports continuum of patient care by identifying patients with gaps in care or need of HEDIS reporting before annual wellness and other visits to ensure services are captured.

• Supports carrier medical record audits for optimum HEDIS/Stars and quality metric reporting.

• Documents and trends findings that support continuous quality improvement initiatives and compliance.

• Collaborates with quality leadership and analytics team on reporting system and technology platforms and participates in performance improvement efforts through completion.

• Communicate findings, opportunities, and outcomes clearly and professionally to all stakeholders

• Demonstrate time management to accommodate meetings, travel, and project deadlines to meet business needs

• Demonstrate excellent guest service to internal team members and patients.

• Perform other related duties as assigned.

• Qualifications

• Bachelor's degree in healthcare or related field, or 7+ years of healthcare experience

• 2+ years of experience working in a payor or healthcare-related field

• 2+ years of managerial experience

• Healthcare: 2 years (Preferred)

• HEDIS: 1 year (Preferred)

• MIPS: 1 year (Preferred)

• Understanding of Hospitalization experiences, the impacts, and needs after discharge.

• Experience with telephonic interviewing skills and working with a diverse population.

• Effective case management and care coordination skills and the ability to assess a member's activities of daily function and independent activities of daily function.

• Ability to develop and implement a care plan that meets the member's needs working in partnership with a care team, preferred.

• Ability to communicate and collaborate with PCP, community, and partners to manage members' care required.

• Ability to work independently in a fast-paced, cross-functional environment.

Compensation Range:

$108,466.00

to

$162,698.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.