Clinical Quality Program Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Ensure adherence to WellSky's Utilization Management and Quality Improvement Program.

• Act as a clinical authority on both state and federal regulations.

• Analyze and present data to identify best practices within post-acute healthcare environments, including LTACHs, IRFs, SNFs, and Home Health facilities.

• Facilitate activities related to performance measurement and outcomes.

• Maintain compliance with CMS, NCQA, and other regulatory requirements.

• Track relevant regulatory updates and assist in their implementation within practices.

• Create and validate reports across various health plan contracts.

• Conduct audits regarding UM decisions, case documentation, turnaround times, and CMS/NCQA stipulations.

• Ensure that the UM Program fulfills NCQA accreditation criteria.

• Organize and lead monthly and quarterly committee meetings.

• Prepare quality reports, analyze trends, and provide actionable recommendations to leadership.

• Assist in corrective action plans when discrepancies in scoring arise.

• Support initiatives aimed at quality improvement projects.

• Prepare for regulatory, accreditation, and contractual audits.

• Contribute to the remediation and documentation of audit findings.

• Execute other assigned responsibilities.

⛳️ Requirements

• A minimum of 4-6 years of relevant experience.

• Proven experience in leading quality improvement projects and participating in committee work.

• Bachelor's Degree or an equivalent level of work experience.

• Active, unrestricted license: RN, PT, OT, or SLP, along with a bachelor's degree in a pertinent field or a combination of education and experience that includes relevant clinical experience and a comprehensive understanding of CMS standards and guidelines.

• At least 1-2 years of experience with NCQA UM accreditation standards.

• Capability to prioritize, plan, and manage multiple tasks and competing deadlines effectively.

• Proficient in data manipulation and organization for analytics and reporting.

• Prior experience managing client compliance SLAs and ensuring successful adherence to SLA requirements.

• Willingness to work additional or irregular hours as required.

• Must comply with applicable security policies and procedures to protect company and client information.

• Ability to sit and view a computer screen for long durations.

• Willingness to travel approximately 10% of the time.

• Candidates for U.S.-based roles must be legally authorized to work in the United States.

🏝️ Benefits

• Comprehensive medical coverage including Rx, dental, and vision benefits.

• Mental health support through an Employee Assistance Program (EAP).

• Generous paid time off policy.

• 13 paid holidays each year.

• 100% vested 401(K) retirement plans.

• Educational assistance of up to $2500 per year.