Clinical Quality & Utilization Manager

Acentra Health; McLean (VA); On-site; USD 88,000 - 105,000; Full time

Benefits offered by this job

Comprehensive health plans

Paid time off

Professional development

Job summary

Acentra Health is seeking a Clinical Quality Manager to oversee training and quality assurance for the Colorado Medicaid Utilization Management Contract. The role reports to the Program Director and works with the administrative team and Medical Director to ensure high-quality contract execution.

The incumbent will lead quality monitoring, guide management and clients on quality issues, focus on risk management, and drive process improvements while ensuring compliance with HIPAA and related

Qualifications

• 3+ years of experience in quality improvement processes.
• 3+ years of Utilization Management (UM) experience within the past 10 years.

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.

Skills

Quality improvement

Utilization Management (UM)

Education

BSN

Tools

MS Office

Job description

Acentra Health is seeking a Clinical Quality Manager to oversee training and quality assurance for the Colorado Medicaid Utilization Management Contract. The role reports to the Program Director and works with the administrative team and Medical Director to ensure high-quality contract execution.

The incumbent will lead quality monitoring, guide management and clients on quality issues, focus on risk management, and drive process improvements while ensuring compliance with HIPAA and related