Quality Care Manager

capitalhealth; Tallahassee (FL); On-site; USD 70,000 - 90,000; Full time

Job summary

Capital Health Plan is seeking a Quality Care Manager in Tallahassee, FL. The role focuses on improving clinical quality, patient safety, and performance measures by analyzing data, conducting reviews, and preparing reports.

This position plays a crucial role in quality audits and compliance with healthcare standards while acting as a resource for quality improvement initiatives. Qualified candidates must have a Bachelor's degree in nursing or a clinical field, clinical licensure, and experience in a healthcare setting.

Qualifications

• Minimum of three years of experience in a clinical healthcare setting.
• Experience in conducting clinical reviews, audits, or quality investigations.
• Ability to coordinate and manage quality projects.

Responsibilities

• Analyze qualitative and quantitative data for performance measures.
• Conduct medical record reviews to support peer review activities.
• Ensure compliance with NCQA, CMS, and State of Florida requirements.

Skills

Clinical data analysis

Report preparation

Communication skills

Documentation for accreditation compliance

Computer applications proficiency

Education

Bachelor's degree in nursing or a clinical field

Clinical licensure in Florida

Job description

Locations: Tallahassee, FL
Department: Clinical Quality & Performance Improvement
F/T or P/T status: Full-time
Schedule: As required

About the role:

We are seeking a Quality Care Manager to support Capital Health Plan's clinical quality, patient safety, and performance improvement efforts. This role analyzes qualitative and quantitative data, conducts clinical reviews, and prepares reports related to performance measures, quality outcomes, and patient safety.

The Quality Care Manager plays a key role in coordinating peer review activities, conducting medical record reviews, supporting quality audits, and ensuring compliance with NCQA, CMS, and State of Florida requirements. This position also serves as a resource across the organization by providing consultation on quality improvement, best practices, accreditation standards, and performance measurement initiatives.

Qualifications

• Bachelor's degree in nursing or a bachelor's degree in a clinical field from an accredited four-year college or university
• Clinical licensure in the State of Florida
• Minimum of three years of experience working in a clinical healthcare setting preferred
• Experience conducting clinical reviews, audits, or quality investigations
• Ability to analyze and interpret qualitative and quantitative clinical data
• Strong written and verbal communication skills, including preparation of reports and presentations
• Ability to coordinate and maintain documentation to support accreditation and regulatory compliance
• Proficiency with computer applications, including word processing, spreadsheets, databases, and web-based tools

Highly Preferred Qualifications

• Experience with quality improvement programs, performance measurement, or accreditation activities
• Familiarity with NCQA standards, CMS Part C and D requirements, and state regulatory requirements
• Experience conducting peer review activities or quality of care investigations
• Strong data analysis and reporting experience related to clinical outcomes and patient safety
• Ability to manage complex quality projects and meet regulatory reporting deadlines
• Are Certified Professional in Healthcare Quality (CPHQ)

About Capital Health Plan (CHP)

CHP is a locally based, not‑for‑profit health maintenance organization serving the Tallahassee region for more than four decades. Founded by community leaders with a mission to deliver high‑quality, affordable, and patient‑centered health care, CHP has grown into a nationally recognized healthcare organization while remaining deeply rooted in the communities it serves.

CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.