Manager Quality Improvement (PQI)

About the role

We are seeking a Manager Quality Improvement (PQI) to join our dynamic team at CalOptima. As a mission-driven organization, we aim to provide excellent healthcare services with dignity, ensuring the needs of each member are respected. This role offers the opportunity to contribute to shaping the future of healthcare, focusing on quality, safety, and equity.

Responsibilities

• Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
• Selects, trains, develops, reviews, and sets department and individual performance goals.
• Maintains consistent workflows, documentation quality, and adheres to regulatory expectations.
• Promotes a culture of accountability, excellence, and continuous improvement with provider partners through exemplary leadership practices.
• Reviews complex and sensitive cases, including those involving potential adverse events, quality of care concerns, and patient safety incidents, and escalates to appropriate review bodies.
• Participates in and presents at CalOptima Health committees, such as Delegation Oversight and the Utilization Management Committee (UMC).
• Facilitates and supports the Credentialing Peer Review Committee (CPRC), working closely with the Committee Chair, medical directors, legal counsel, members, and providers to ensure cases are reviewed fairly and that the Committee's recommended actions are implemented.
• Collaborates and contributes PQI data, analysis, and activities to the Quality Improvement Health Equity Transformation Program (QIHETP) Description, Work Plan, and annual Evaluation.
• Develops, maintains, and evaluates the QIHETP and Work Plan in collaboration with leadership and ensures documents comply with accreditation, contractual, and regulatory requirements.

Requirements

• Bachelor's degree in nursing PLUS 5 years of experience in clinical operations, quality, or grievances within a managed care setting.
• 2 years of supervisory or lead experience.
• 2 years of experience conducting provider-related Potential Quality Issue (PQI) reviews, quality-of-care investigations, or assessments involving suspected deviations from accepted clinical standards, patient safety expectations, or professional performance requirements.

Qualifications

• Master's degree in nursing, health care, or related field.
• Certification in quality or process improvement (e.g., Certified Professional in Healthcare Quality, Lean Six Sigma Green Belt).
• 2 years of experience in quality management or improvement within a managed care setting.
• 2 years of experience in an acute care hospital.

Skills

• Develops and maintains effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Communicates clearly and concisely, both orally and in writing.
• Works independently and exercises sound judgment.
• Manages multiple projects and identifies opportunities for internal and external collaboration.
• Motivates and leads multi-program teams and external committees/coalitions.
• Utilizes computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Benefits

Competitive compensation, CalPERS pension program, additional retirement packages, comprehensive benefits package, tuition reimbursement, professional development opportunities, career development opportunities, flexible scheduling, and the satisfaction of directly impacting healthcare access for thousands of individuals and families.

Pay

The current pay grade range for this role is: Pay Grade: 314 - $99,902 - $159,843 ($48.03 - $76.8476). The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role, and internal equity among other factors.

Schedule

This position is approved for Full Telework (if the position is Telework, it is eligible in California only). Training will be held in the office for the first 3 weeks from 8:00am - 5:00pm, on Tuesdays and Thursdays.

Ways We Are Here For You

You'll enjoy a generous PTO program, a quality work-life balance, various wellness programs, and professional development opportunities. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

Physical Requirements

Ability to visually read information from computer screens, forms, and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing, and reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting. Lifting and moving objects, patients, and/or equipment less than 10 pounds.

Why Join Us

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input. We are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impact on our community members.

Next Steps

All applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. If you want to join our team, the deadline for the first review of applications is July 6, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.