Quality Improvement Manager — Partial Telework

CalOptima Health Partnership; Orange (CA); Hybrid; USD 100,000 - 160,000; Full time

Benefits offered by this job

Partial Telework

Competitive compensation

CalPERS pension program

Tuition Reimbursement

Professional development opportunities

Flexible scheduling

Job summary

CalOptima Health seeks a Manager Quality Improvement to lead PQI operations, drive investigations and promote patient safety. The role collaborates with medical management, compliance, and provider partners to address quality issues and improve outcomes.

You will oversee policy development, QA reviews and health equity initiatives, while supporting a partial telework arrangement and required California presence at the main Orange office two days weekly.

Qualifications

• Bachelor’s degree in nursing and 5+ years of experience in clinical operations, quality or grievances within a managed care setting.
• 2 years of supervisory or lead experience required.
• 2 years of experience conducting provider-related Potential Quality Issue (PQI) reviews, quality-of-care investigations, or assessments.

Responsibilities

• Lead day-to-day PQI operations including intake, triage, investigation, case review and closure.
• Collaborate with Medical Management, Provider Relations, Office of Compliance and other departments to gather case information for fair evaluations.
• Develop and maintain PQI policies, procedures and related quality sections of CalOptima Health documents.
• Oversee PQI data, analysis and reporting and contribute to the QIHETP Description, Work Plan and annual Evaluation.

Skills

Leadership

Communication

Project management

Analytical

Team collaboration

Education

Bachelor’s degree in nursing

Tools

Microsoft Office

Care management system

Job description

CalOptima Health seeks a Manager Quality Improvement to lead PQI operations, drive investigations and promote patient safety. The role collaborates with medical management, compliance, and provider partners to address quality issues and improve outcomes.

You will oversee policy development, QA reviews and health equity initiatives, while supporting a partial telework arrangement and required California presence at the main Orange office two days weekly.