Clinical Quality, Manager

About the role

Acentra Health is looking for a Clinical Quality Manager to join our growing team. Under general supervision of the Program Director and in collaboration with the administrative team and Medical Director, the Clinical Quality Manager oversees all training and quality assurance activities of the Colorado Medicaid (HCPF) Utilization Management Contract. The Clinical Quality Manager also assists with the development of requirements for system configuration and reports.

Responsibilities

• Ensure that the program meets or exceeds all contract Performance Standards.
• In collaboration with Program Director, UM Manager, and clinical supervisors, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Oversee contract-specific Quality Program, providing guidance to the management team and clients regarding quality-related issues.
• Focus on risk management, operations and infrastructure, performance monitoring and improvement, and consumer protection and empowerment in the day-to-day management of quality assurance activities for the contract.
• Manage program staff Internal Rate of Return (IRR) and clinical documentation audit processes.
• Work collaboratively with our client and stakeholders to develop training and process improvements.
• Consult with other program managers and supervisors regarding member and/or provider complaints and grievances, as needed.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
• The above list is not intended to be all-inclusive and may be expanded to include other duties that the management may deem necessary from time to time.

Qualifications

• Bachelor of Science in Nursing degree BSN (MSN preferred).
• An active, unrestricted, Colorado Registered Nurse (RN) OR compact state license.
• 3+ years of experience in quality improvement processes.
• 3+ years of Utilization Management (UM) experience within the past 10 years.

Preferred Qualifications

• Health First Colorado/Medicaid knowledge.
• Demonstrated accountability and commitment to high performance, with the ability to work independently and collaboratively to achieve departmental goals.
• Knowledge of Utilization Review Accreditation Commission (URAC) standards.
• Strong organizational skills with the ability to adapt to change, manage multiple priorities, and meet competing deadlines.
• Knowledge and willingness to become a subject matter expert and thought leader for designated program(s).
• Demonstrated proficiency in MS Office applications.
• Excellent verbal and written communication skills with a strong customer service orientation.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness.
• Educational assistance.
• Corporate discounts.

Pay

USD $88,480.00 - USD $105,000.00 /Yr.