Clinical Quality Program Manager

United States

Apply with AI Apply

Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Post-acute CareIndustries

Requirements

Candidates must possess a Bachelor's Degree or equivalent work experience, with 4-6 years of relevant experience in healthcare quality management and post-acute care utilization management. Preferred qualifications include being a Registered Nurse, Occupational Therapist, or Physical Therapist with a related bachelor's degree, or equivalent education and experience including clinical experience and understanding of CMS standards. Experience with CMS and/or NCQA audits, ability to manage multiple priorities, strong communication skills, proficiency in data manipulation and analysis, and case management experience are also preferred. Candidates must be legally authorized to work in the US and willing to work additional hours as needed.

Responsibilities

The Clinical Quality Program Manager will ensure compliance with WellSky's Utilization Management and Quality Improvement Program by acting as a clinical expert on state and federal regulations. Responsibilities include facilitating performance measurement and outcomes activities, ensuring adherence to CMS, NCQA, and other regulatory standards, and staying updated on regulatory changes. The role involves guiding the implementation of internal audit protocols, analyzing data to identify trends and areas for improvement, executing projects to enhance care quality, and generating reports for performance and compliance monitoring. Additionally, the manager will prepare for audits, contribute to remediation efforts, and perform other assigned duties.

Skills

Healthcare Quality Management

Utilization Management

Post-acute Care

Regulatory Compliance

CMS Regulations

NCQA Standards

Data Analysis

Performance Measurement

Audit Protocols

Clinical Documentation

Registered Nurse

Occupational Therapist

Physical Therapist

WellSky

Healthcare software and community care solutions

About WellSky

WellSky offers software and services to improve health and community care, making it easier for providers and patients to access and navigate care. Its products, like the WellSky Value Based Care Suite, integrate with Electronic Health Record (EHR) systems to enhance care coordination. WellSky stands out by providing a comprehensive range of solutions, including strategic consulting and revenue cycle management, which help clients operate more efficiently. The company's goal is to enhance care delivery and improve individuals' quality of life through effective solutions.

Reston, VirginiaHeadquarters

1980Year Founded

$34.5MTotal Funding

DEBTCompany Stage

Social Impact, HealthcareIndustries

1,001-5,000Employees