Manager, Quality Practice Advisor

About the Role

The position is responsible for providing leadership and direction for clinical, quality, and risk adjustment functions. You will execute on the development and oversight of clinical programs for physician education and communication, as well as develop your team in activities to increase member quality of care, reduce costs, and identify risk adjustment opportunities. This role involves providing and analyzing reports to identify trends and opportunities, and recommending actions. You will coordinate with other departments to prioritize provider engagement and communication opportunities for all clinical, quality, and risk adjustment projects.

Responsibilities

• Establish and maintain tracking and monitoring systems for healthcare quality improvement activities according to regulatory requirements, risk adjustment policies and procedures, and contractual agreements.
• Ensure high-risk, high-volume, and unusual events are monitored concurrently and retrospectively as they occur.
• Manage and evaluate the performance of staff related to clinical and healthcare services performance improvement activities.
• Provide guidance, training, and development to all department associates.
• Coordinate guidelines, studies, and performance improvement activities in concert with quality management, pharmacy services, and risk management programs.
• Maintain a knowledge base of HEDIS requirements and implement clinical performance methods to improve HEDIS performance.
• Coordinate all external programmatic oversight visits for contracted providers and ensure timely completion and follow-up on corrective action plans.

Requirements

• A bachelor’s degree in Health Care, Nursing, Public Health Administration, or Business, or equivalent work experience is required.
• 3 or more years of supervisory/management experience.
• 5+ years of experience working in a managed care environment.
• Registered Nurse, Certified Health Care Risk Management certification, Foreign MD, or American Academy of Professional Coders certification preferred.

Pay

Pay Range: $87,700.00 - $157,800.00 per year. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules

Benefits may be subject to program eligibility.