Position Overview
We are in search of an innovative and experienced leader to drive clinical quality improvement initiatives within our organization. This remote role involves overseeing clinical quality management programs, including accreditation compliance and the execution of clinical audits. The ideal candidate will possess a comprehensive understanding of NCQA requirements and will spearhead continuous quality improvement efforts utilizing HEDIS and other performance metrics. Your contributions will be pivotal in reporting and analyzing the quality of member care while formulating strategies aimed at enhancing health outcomes.
Key Responsibilities
- Provide visionary leadership and strategic guidance to various management levels and senior professionals.
- Propel the execution of strategies that influence extensive business units and diverse operational sites.
- Champion initiatives that tackle intricate business dilemmas across multiple functions or departments.
- Design and implement plans that positively affect customer outcomes for both internal and external stakeholders.
- Collaborate with cross-functional teams to ensure clinical quality programs align with business objectives and accreditation criteria.
Career Growth Opportunities
In this role, you will be acknowledged for your accomplishments in an environment that not only challenges you but also provides clear metrics for success. You will have the potential to expand into additional roles and responsibilities within the organization, facilitating your career progression and professional development.
Qualifications
Required:
- Minimum of 5 years of clinical experience.
- At least 3 years in clinical quality management.
- A minimum of 3 years in managed care or the insurance industry.
- Proven ability to lead with a strategic mindset and develop actionable plans that enhance performance.
- Subject matter expert in CMS Special Needs Plans Models of Care (SNP MOC).
- Strong presentation skills, capable of engaging senior leadership effectively.
Preferred:
- Experience in managing large-scale projects within a complex and matrixed organization.
- Familiarity with document management and archival practices.
- Expertise in drafting Models of Care for NCQA submissions.
- Knowledge of member complaint processes and compliance requirements.
Compensation And Benefits
- The hourly wage for California residents ranges from $16.00 to $20.05 per hour, influenced by factors such as education, experience, and local market conditions.
- A robust benefits package is available, including health insurance, stock purchase plans, 401k contributions, and more (eligibility requirements apply).
Join us and experience a work environment that fosters your career growth while balancing flexibility and professional development opportunities.
Employment Type: Part-Time
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