Clinical Quality, Manager

Acentra; Northern (KY); Hybrid; USD 88,000 - 105,000; Full time

Benefits offered by this job

Comprehensive health plans

Paid time off

Retirement savings

Corporate wellness

Educational assistance

Corporate discounts

Job summary

Acentra Health is seeking a Clinical Quality Manager to supervise all training and quality assurance for the Colorado Medicaid UM contract. You will work under the Program Director and Medical Director to ensure program compliance and guide system configuration and reporting needs.

Responsibilities include leading quality monitoring, collaborating with stakeholders to develop training and process improvements, and ensuring adherence to HIPAA and privacy rules.

Qualifications

• BSN degree and active RN license.
• 3+ years quality improvement experience.
• 3+ years Utilization Management (UM) experience in the past 10 years.

Responsibilities

• Ensure that the program meets or exceeds all contract Performance Standards.
• Lead quality monitoring activities and identify areas for improvement with plan implementations.
• Oversee contract-specific Quality Program and provide guidance to management and clients.
• Focus on risk management, operations, performance monitoring and improvement, and consumer protection.

Skills

RN license

Quality improvement

Utilization Management

BSN

Medicaid knowledge

Education

BSN (MSN preferred)

Tools

MS Office

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities

Acentra Health is looking for a Clinical Quality, Manager to join our growing team.

Job Summary

Under general supervision of the Program Director and in collaboration with the administrative team and Medical Director, the Clinical Quality Manager oversees all training and quality assurance activities of the Colorado Medicaid (HCPF) Utilization Management Contract.

The Clinical Quality Manager also assists with the development of requirements for system configuration and reports.

Responsibilities

• Ensure that the program meets or exceeds all contract Performance Standards.
• In collaboration with Program Director, UM Manager, and clinical supervisors, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Oversee contract-specific Quality Program, providing guidance to the management team and clients regarding quality-related issues.
• Focus on risk management, operations and infrastructure, performance monitoring and improvement, and consumer protection and empowerment in the day-to-day management of quality assurance activities for the contract.
• Manage program staff Internal Rate of Return (IRR) and clinical documentation audit processes.
• Work collaboratively with our client and stakeholders to develop training and process improvements.
• Consult with other program managers and supervisors regarding member and/or provider complaints and grievances, as needed.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The above list is not intended to be all-inclusive and may be expanded to include other duties that the management may deem necessary from time to time.

Qualifications

Required Qualifications

• Bachelor of Science in Nursing degree BSN (MSN preferred).
• An active, unrestricted, Colorado Registered Nurse (RN) OR compact state license.
• 3+ years of experience in quality improvement processes.
• 3+ years of Utilization Management (UM) experience within the past 10 years.

Preferred Qualifications

• Health First Colorado/Medicaid knowledge
• Demonstrated accountability and commitment to high performance, with the ability to work independently and collaboratively to achieve departmental goals.
• Knowledge of Utilization Review Accreditation Commission (URAC) standards.
• Strong organizational skills with the ability to adapt to change, manage multiple priorities, and meet competing deadlines.
• Knowledge and willingness to become a subject matter expert and thought leader for designated program(s).
• Demonstrated proficiency in MS Office applications.
• Excellent verbal and written communication skills with a strong customer service orientation.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

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

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Compensation

The pay range for this position is listed below.

Pay Range

USD $88,480.00 - USD $105,000.00 /Yr.

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.