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Role Description

As the Manager, Clinical Quality Improvement, you will lead a team of dedicated LVNs/RNs in support of organizational quality improvement initiatives across Medicare, Medicaid and Commercial space. You will partner with other departments, health plans and providers to develop and monitor quality improvement plans, and report out to leaders. This position offers the opportunity to not only engage at the local level, but also engage at a system/national level in the population health space.

• Negotiate project timelines, coordinate action plans, and analyze results to align with strategic goals.
• Collaborate with medical groups and health plans, establishing and maintaining quality improvement programs.
• Lead QI committees, ensuring compliance with regulatory standards (DMHC, DHCS, CMS, NCQA).
• Manage QI documentation like the Work Plan, Program Description, and Annual Evaluation.
• Identify and address programmatic weaknesses through Corrective Action Plans, driving ongoing improvement.
• Conduct data analysis in collaboration with IT, defining outcome benchmarks, and developing performance dashboards.
• Oversee critical programs such as HEDIS submissions, CMS Stars, and Pay for Performance.
• Lead, develop, and present to senior leadership, managing both office-based and remote QI staff.
• Drive change and ensure sustained quality across all clinical operations.

This position is work from home within California.

Qualifications

• Clear and current CA Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license.
• 5 years of Quality Management experience in managed care health plan setting or medical group.
• 5 years of oversight and management of clinical and non-clinical quality management staff.
• 3 years HEDIS measures reporting and experience in CMS Stars, P4P, ACO and Value Based Payment Programs.
• 3 years Medical record review project management.
• Bachelors degree or equivalent in health sciences or related field.
• Knowledge of quality improvement tools and methodology, such as PDSA, Lean, Six Sigma, and Statistical Process Control Analysis.
• Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes.
• Strong communication and presentation skills; training/meeting facilitation skills a plus.
• Strong team building and interpersonal skills.
• Ability to utilize sound judgment and promptly report potential risks.

Requirements

• 2 years of clinical experience in an acute care setting, long term care facility or home health care preferred.
• Masters degree preferred.
• Certified Professional in Healthcare Quality (CPHQ) or Certified Mastered Black Belt or Lean Six Sigma Black Belt Certification or Six Sigma Black Belt preferred.
• Experience with medical risk adjustment preferred.

Benefits

• Outstanding Total Rewards package that integrates competitive pay with a flexible Health & Welfare benefits package.
• Cafeteria-style benefit program with options including medical, dental and vision plans for employees and their dependents.
• Health Spending Account (HSA), Life Insurance, and Long Term Disability.
• 401k retirement plan with a generous employer-match.
• Paid Time Off and Sick Leave.