Manager Clinical Quality Improvements

Commonspirit; Bakersfield (CA); Remote; Full time

Job summary

Commonspirit is seeking a Manager of Clinical Quality Improvements to lead quality initiatives within Medicare and Medicaid. This remote position involves team leadership, managing regulatory compliance, and data analysis to optimize health care quality. Qualified candidates should have a clinical license and significant experience in quality management.

Benefits

Flexible Health & Welfare benefits

401k retirement plan with employer-match

Paid Time Off

Sick Leave

Qualifications

• CA Clinical licensure (RN, LVN, LCSW, NP, PA).
• 5 years of quality management experience in health plan setting.
• 3 years in HEDIS measures reporting.

Responsibilities

• Lead quality improvement initiatives across Medicare and Medicaid.
• Coordinate action plans and monitor results.
• Engage with various departments and provide expertise.

Skills

Quality Management

Data Analysis

Leadership

Regulatory Standards Interpretation

Education

Bachelor's degree in health sciences or related field

Master’s degree (MPH, MPA, MA)

Job description

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• This position is remote/work from home within California.*
  
  

*Responsibilities*

• This position is remote/work from home within California.*
  
  

This position will lead a team of dedicated LVNs/RNs in support of organizational quality improvement initiatives across Medicare, Medicaid and Commercial space. He/She 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.

Position Summary

The Manager, Clinical Quality Improvement, is responsible for leading multiple large scale, local or organization-wide, quality improvement initiatives. This position is also responsible for negotiating timelines and priorities for projects, coordinating action plans, and monitoring/analyzing results for projects that are consistent with the organization's strategic goals. The Manager, Clinical Quality Improvement will oversee the day-to-day management of the QM department, acts as a liaison between the MSO’s medical groups and contracted health plans, works collaboratively throughout the organization to lead and establish appropriate quality improvement programs.

Responsibilities May Include

• Provides expertise in the interpretation, implementation, and maintenance of regulatory standards (e.g., DMHC, DHCS, CMS, NCQA).
• Stays abreast of quality measures and industry best practices to optimize performance.
• Creates or updates Policies and Procedures to ensure compliance with regulatory requirements.
• Leads the identification of improvement opportunities and solutions to improve quality. Coordinates, facilitates and ensures sustainability of quality initiatives.
• Performs data analysis to drive actions based on data-driven insights.
• Defines expected outcomes & benchmarks based on quality metrics.Participates in the development of meaningful dashboards and tools to track process and outcome measures (Provider Score Cards, Gaps in Care reports).
• Designs workflows, disseminates data and communicates shared learning.
• Perform other duties and special projects as assigned.
  
  

*Qualifications*

Minimum Qualifications

• CA Clinical licensure (Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Clinical Social Worker (LCSW), NP, PA,).
• 5 years of Quality Management (QM) experience in managed care health plan setting or medical group.
• 5 years of oversight/supervision/management/leadership 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.
• Bachelor’s degree or equivalent in health sciences or related field.
  
  

Preferred Qualifications

• 2 years of clinical experience in an acute care setting, long term care facility or home health care, strongly preferred.
• Master’s degree (MPH, MPA, MA), strongly preferred.
• Certification in Health Care Quality and Management (CHCQM) or Certified Professional in Health Care Quality (CPHQ), strongly preferred
• LEAN or Six Sigma Greenbelt, strongly preferred
  
  

*Overview*

• This position is remote/work from home within California.*
  
  

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

*Pay Range*

$40.66 - $58.96 /hour

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Wellness and Fitness Services, Hospitals and Health Care, and Medical Practices

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