Clinical Quality Program Manager
Core
Lead state-level quality improvement programs and Accreditation readiness activities, ensuring compliance with NCQA standards and regulatory expectations for healthcare members.
Role type
Senior Clinical Quality Program Manager
Builds
State-level quality improvement initiatives and Accreditation readiness deliverables
Domain
Healthcare / Health Insurance / Quality Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
NCQA Accreditation standards knowledge, quality management principles, healthcare regulatory compliance, project management, cross-functional team leadership, process improvement, data analysis, stakeholder coordination
Preferred skills
CPHQ certification, MS in health field, experience leading cross-functional teams for Accreditation readiness
Technologies
NCQA standards, regulatory frameworks, quality improvement methodologies
Responsibilities
Lead state level quality strategy meetings and develop quality plans; Serve as subject matter expert for Accreditation readiness and interpret NCQA standards; Partner with business leaders to establish and track Accreditation milestones; Design studies to identify barriers to medical interventions; Ensure sound study methodology and appropriate reporting; Develop performance improvement plans to enhance quality of care; Maintain effective documentation of research programs; Coordinate Accreditation work plans, evidence collection, and gap assessments; Provide oversight for quantitative analysis of clinical data; Lead interactions with regulators or oversight entities; Identify opportunities to improve processes and operational controls; Develop and deliver education on Accreditation requirements and quality standards.