Manager, Quality Practice Advisor

Jobgether; United States; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Remote or hybrid options

Medical insurance

401(k) and stock purchase plan

Tuition reimbursement and professional

Paid time off and holidays

Flexible work arrangements

Job summary

Jobgether seeks a Manager, Quality Practice Advisor in the United States to lead clinical quality, improvement, and risk adjustment initiatives within a managed care environment. This role involves program oversight, provider engagement, and performance analysis to drive better health outcomes and cost effectiveness.

You will monitor quality data, guide intervention strategies, and coordinate across clinical, quality, pharmacy, risk, and provider teams to ensure regulatory readiness and

Qualifications

• Bachelor's degree or equivalent professional experience.
• 3+ years supervisory/management experience.
• 5+ years in a managed care environment.
• Strong understanding of clinical quality improvement and risk adjustment.
• Experience using data to drive decisions.
• Excellent collaboration and communication skills.

Responsibilities

• Lead and direct clinical, quality, and risk adjustment functions to improve member outcomes and cost effectiveness.
• Develop programs focused on physician education, provider communication, and quality improvement.
• Coordinate provider engagement and align cross-functional initiatives.
• Establish tracking and reporting systems for quality improvement in line with regulations and contracts.
• Monitor high-risk events and ensure corrective actions.
• Analyze reports to identify trends and opportunities for action.
• Provide coaching, training, and development to staff.

Skills

Leadership

Quality improvement

Risk adjustment

Healthcare management

Education

Bachelor's degree in Healthcare or related field

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager, Quality Practice Advisor based in United States. This role provides leadership across clinical quality, quality improvement, and risk adjustment initiatives within a managed care environment. You will help shape programs that improve the quality of care, support better health outcomes, and identify opportunities to reduce costs. The position combines people leadership, clinical program oversight, provider engagement, and performance analysis. You will use quality data and reporting to identify trends, prioritize opportunities, and recommend meaningful interventions. The role also plays an important part in physician education, regulatory readiness, and continuous performance improvement. Success requires strong collaboration across clinical, quality, pharmacy, risk, and provider-facing teams. This is an opportunity to influence healthcare delivery while developing teams and driving measurable improvements in quality and performance.

Accountabilities

• Lead and provide direction for clinical, quality, and risk adjustment functions, ensuring programs support improved member outcomes, quality of care, and cost effectiveness.
• Develop and oversee clinical programs focused on physician education, provider communication, quality improvement, and risk adjustment opportunities.
• Partner with cross-functional departments to prioritize provider engagement activities and coordinate clinical, quality, and risk adjustment initiatives.
• Establish and maintain tracking, monitoring, and reporting systems for healthcare quality improvement activities in line with regulatory requirements, policies, procedures, risk adjustment standards, and contractual commitments.
• Monitor high-risk, high-volume, and unusual events through concurrent and retrospective review, ensuring appropriate follow-up and corrective action.
• Analyze performance reports and quality data to identify trends, gaps, opportunities, and recommended actions.
• Lead and evaluate team performance, providing direction, coaching, training, and professional development to department associates.
• Coordinate quality guidelines, studies, and performance improvement initiatives alongside quality management, pharmacy services, and risk management programs.
• Maintain strong knowledge of HEDIS requirements and translate clinical performance insights into initiatives designed to improve HEDIS results.
• Coordinate external programmatic oversight visits for contracted providers, ensuring required activities, documentation, follow-up, and corrective action plans are completed on schedule.

Requirements

• Bachelor's degree in Healthcare, Nursing, Public Health Administration, Business, or a related discipline; equivalent relevant professional experience may also be considered.
• At least 3 years of supervisory or management experience, with demonstrated ability to lead, coach, and develop teams.
• 5+ years of experience working in a managed care environment.
• Strong understanding of clinical quality improvement, healthcare performance management, risk adjustment, and provider engagement.
• Working knowledge of HEDIS requirements and quality performance improvement methodologies.
• Experience using reports, data, and performance metrics to identify trends, evaluate opportunities, and support evidence-based decisions.
• Strong organizational, analytical, critical-thinking, and problem-solving skills, with the ability to manage multiple priorities and deadlines.
• Excellent communication and collaboration skills, including the ability to work effectively with clinical, operational, provider, and cross-functional stakeholders.
• Demonstrated ability to provide guidance and training while fostering accountability, continuous improvement, and professional development.
• Preferred credentials include Registered Nurse (RN), Certified Health Care Risk Management certification, Foreign Medical Doctor (MD), or American Academy of Professional Coders (AAPC) certification.
• Ability to work effectively in a remote environment while maintaining strong stakeholder engagement and team leadership.

Benefits

• Annual salary range of $87,700 - $157,800, with actual compensation determined by factors such as skills, experience, education, job-related qualifications, and work status.
• Potential additional incentive compensation as applicable.
• Medical and other health insurance benefits.
• 401(k) and stock purchase plan opportunities.
• Tuition reimbursement and professional development support.
• Paid time off and holidays.
• Flexible work arrangements, including remote, hybrid, field, or office-based options depending on role and business needs.
• A purpose-driven environment focused on improving healthcare access, quality, and outcomes.
• Benefits are subject to applicable eligibility requirements and program terms.