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Quality Clinical Manager

Job Posting
Quality Clinical Manager
Greensboro, NC • Operations

Job Summary

The Quality Clinical Manager is responsible for coordinating the design, development, implementation, and evaluation of the health plan's clinical quality functions. Collaborates with Care Management and Utilization Management to improve health status for chronic diseases based on demographic and epidemiological characteristics of the plan membership. Works with plan leaders to develop the model of care (MOC) and chronic condition improvement plans (CCIP) that are required by CMS. Will work with the Director of Quality to ensure the quality initiatives, and all processes are in compliance with applicable laws and regulations.

Major Work Activities

Develops, implements, and manages the strategic plans for the quality improvement programs, including working with leadership on the better approach to structure and effectiveness for quality improvement processes
Continually assesses the tactical processes to achieve program objectives: Develop educational pieces explaining the quality improvement programs for providers and other partners.
Leads, develops, and manages work plans, establishes deadlines, assigns responsibilities, monitors overall project progress, and reports progress regularly to internal stakeholders for the plan member health plans.
Defines develops, organizes, and communicates program interventions and analytical plans to support quality improvement initiatives, Quality Improvement Programs (QIP), Chronic Care Improvement Projects (CCIP). Collects analyze, summarizes information and trends, consults on research projects, and recommends actions to improve quality measures in support of Star rating goals.
Collaborates across the company and with vendors to help ensure the integration and alignment of quality strategies
Management of vendors identified to meet quality initiatives.
Leads staff assigned to Clinical Quality; provides guidance and mentoring of staff, and builds effective teams (both internally and with vendors) to achieve established goals and within established budgets
Demonstrates the ability to lead and influence others positively to achieve desired goals of HTA
Performs other duties as assigned.



Minimum Qualifications

Required Education

Bachelor’s Degree Nursing or other clinical degrees (NP, PA, PharmD)

Required Experience

3+ years clinical experience
3+ years quality experience
3+ years experience working with a health insurance company
Experience working with vendors
Experience leading initiatives
Proficient in Word, Excel, and PowerPoint
Knowledge, Skills, and Abilities

Working knowledge of CCIP and Model of Care
Working knowledge of Medicare Advantage and Part D laws and regulations
Experience with quality improvement programs
Skills Strong in the following competencies:

Decision making/Judgment
Problem solving/Analysis
Creativity/Innovation N/A
Preferred Qualifications

Preferred Education

Master’s degree in nursing

Preferred Experience

Experience working for a health insurance company
Experience working with regulatory agencies (CMS)
Experience performing clinical data analysis
Preferred Knowledge, Skills, and Abilities

Experience with quality improvement programs

Time:  Full time
Salary:  Salary
Category:  Operations

Updated: 5/7/2021 11:54:01 AM

Job Contact:
Michael Abner

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7800 McCloud Road
Greensboro, NC 27409