Clinical Quality Program Manager

Jobtailor; Town of Florida (NY); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Jobtailor is seeking a Quality Improvement leader to oversee multi-state initiatives, drive HEDIS performance improvements, and align QI activities with regulatory standards. The role requires licensure in medical/behavioral health, strong data analysis, and experience guiding cross-functional teams.

The candidate will lead root cause analyses, develop intervention strategies, and ensure robust reporting and documentation to meet accreditation demands.

Qualifications

• Current unrestricted license related to the medical or behavioral health field.

Responsibilities

• Serve as a liaison and oversee quality improvement activities, projects, and programs for one or more states.
• Participate in quality strategy activities and lead assigned quality improvement initiatives.
• Integrate improvement activities into overall business processes.
• Lead root cause analyses to identify drivers of HEDIS performance gaps.
• Develop data-informed recommendations and intervention strategies.
• Ensure sound study methodology and appropriate reporting.
• Develop performance improvement plans.
• Oversee clinical quality improvement activities and projects to improve member care quality.
• Assure compliance with corporate QI work plans.
• Ensure QI activities address targeted population needs.
• Maintain documentation of research programs to meet regulatory and accreditation standards.
• Partner with Analytics and cross-functional stakeholders to develop reporting and interpret HEDIS data.
• Identify opportunities for quality improvement.
• Oversee implementation of new initiatives.
• Lead interactions with regulators or oversight entities.
• Oversee quality improvement activities for the largest and most complex state programs

Education

BS in health administration, nursing, or a related clinical field

MS in health field

Job description

Serve as a liaison and oversee quality improvement activities, projects, and programs for one or more states within a major line of business
Participate in quality strategy activities and lead assigned quality improvement initiatives
Integrate improvement activities into overall business processes
Lead root cause analyses to identify drivers of HEDIS performance gaps
Develop data-informed recommendations and intervention strategies
Ensure sound study methodology and appropriate reporting
Develop performance improvement plans
Oversee clinical quality improvement activities and projects to improve member care quality
Assure compliance with corporate QI work plans
Ensure QI activities address targeted population needs
Maintain documentation of research programs to meet regulatory and accreditation standards
Partner with Analytics and cross-functional stakeholders to develop reporting and interpret HEDIS data
Identify opportunities for quality improvement
Oversee implementation of new initiatives
Lead interactions with regulators or oversight entities
Oversee quality improvement activities for the largest and most complex state programs

Requirements

• Current unrestricted license related to the medical or behavioral health field, or certification in an applicable field (i.e. CPHQ)
• BS in health administration, nursing, or a related clinical field; 4 years of health care quality or data analysis experience; or any combination of education and experience providing an equivalent background
• HEDIS knowledge and experience supporting HEDIS quality improvement initiatives preferred
• Experience interpreting healthcare quality data to identify trends, root causes, and improvement opportunities preferred
• MS in the health field (i.e. Nursing) preferred
• Ability to work Monday–Friday, 8:30 am to 5:00 pm EST
• Ability to work in-office 1–2 days per week within commuting distance of an office
• Must meet applicable COVID-19 and Influenza vaccination requirements for certain patient/member-facing roles

Core Competencies

Demonstrates expertise in quality improvement initiatives within healthcare, focusing on HEDIS performance, data analysis, and compliance with regulatory standards. Proven ability to lead cross-functional teams and develop data-informed strategies to enhance member care quality.

Highest-signal resume keywords

• HEDIS Knowledge
• Quality Improvement Initiatives
• Data Analysis Experience
• Clinical Quality Oversight
• CPHQ Certification

Hard Skills

• Quality Improvement
• Data Analysis
• Root Cause Analysis
• Performance Improvement Plans
• Healthcare Quality Data Interpretation
• Study Methodology
• Regulatory Compliance
• Documentation Management
• Intervention Strategies
• Quality Strategy Development

Soft Skills

• Leadership
• Collaboration
• Communication
• Problem-Solving
• Stakeholder Engagement

Certifications & Qualifications

• CPHQ
• Unrestricted Medical License

Industry Keywords

• Healthcare Quality
• HEDIS
• Clinical Quality Improvement
• Accreditation Standards
• Quality Improvement Work Plans