Quality Improvement Manager, PQI - Hybrid

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

Benefits offered by this job

Comprehensive benefits

CalPERS pension program

Job summary

CalOptima is seeking a Manager Quality Improvement to lead PQI operations, supervise a team, and ensure regulatory and contractual quality standards are met. You will collaborate with Medical Management, Provider Relations and Compliance, while advancing health equity initiatives and program development.

The role supports partial telework with in-office requirements in Orange, CA, and requires California RN licensure with a BSN or higher. Strong leadership and regulatory experience are essential.

Qualifications

• Bachelor's degree in nursing; CA RN license.
• 5+ years in clinical operations, quality or grievances within managed care.
• 2+ years supervisory or lead experience.
• 2+ years in PQI reviews or quality-of-care investigations.

Responsibilities

• Leads leadership functions, directing department and staff; sets performance goals.
• Oversees PQI operations: intake, triage, investigation, case review and closure.
• Develops PQI policies, procedures and reports; ensures regulatory compliance.
• Collaborates with IT to support PQI systems and reporting capabilities.
• Contributes to the QIHETP and Work Plan; participates in audits and reviews.

Skills

RN license in CA

Quality improvement

Supervisory experience

PQI reviews

Leadership in healthcare

Education

Bachelor's degree in nursing

Tools

Microsoft Office

Care management system

Job description

CalOptima is seeking a Manager Quality Improvement to lead PQI operations, supervise a team, and ensure regulatory and contractual quality standards are met. You will collaborate with Medical Management, Provider Relations and Compliance, while advancing health equity initiatives and program development.

The role supports partial telework with in-office requirements in Orange, CA, and requires California RN licensure with a BSN or higher. Strong leadership and regulatory experience are essential.