Manager, Clinical Quality

Overview:

• Responsible for management and oversight of activities related to quality assurance and monitoring of clinical UM and A&G staff.
• Provides effective and efficient solutions to complex business problems.
• Maintains effective relationships key vendors, and clients to ensure that the clinical quality issues are represented.

Responsibilities:

• Oversight of key metrics, including quality, productivity, and compliance.
• Support all related compliance audits on behalf of health management programs.
• Ensures subject matter expertise and support related to clinical quality management inquiries.

Employment Qualifications:

• Active RN license is required.
• 10+ years experience with progressive responsibility in healthcare administration, clinical quality or a health plan with demonstrated technical knowledge.
• 5+ years management experience in Health Management required with a focus on Quality and Utilization Management.