Manager of Quality Improvement- Bakersfield 1.2 at Universal Healthcare MSO LLC

Bakersfield, California, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Apr, 26

Salary

48.24

Posted On

13 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Quality Improvement, Supervision, Coaching, Training, Performance Monitoring, Regulatory Compliance, Data Analysis, Problem Solving, Collaboration, Communication, Organizational Skills, Attention to Detail, Healthcare Quality, HEDIS, CMS Standards, Leadership

Industry

Hospitals and Health Care

Description

Description Location: Bakersfield, CA (Onsite) Classification: Full-Time/Exempt This position is exempt and will be paid on a salaried basis. Schedule: Monday-Friday 8am-5pm Benefits: · Medical · Dental · Vision · Paid Time Off (PTO) · Floating Holiday · Simple IRA Plan with a 3% Employer Contribution · Employer Paid Life Insurance · Employee Assistance Program Compensation: The initial pay range for this position upon commencement of employment is projected to fall between $38.60 and $48.24. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you. Position Summary: The Quality Manager is responsible for the day-to-day coordination and operational oversight of the organization’s Quality Improvement activities. This role ensures accurate reporting, compliance with CMS, DHCS, and NCQA standards, and timely completion of deliverables related to HEDIS, Stars, Quality Improvement Projects (QIPs), Chronic Care Improvement Programs (CCIP), and the annual Quality Work Plan. The Quality Manager supports the Quality Director and Medical Director in preparing regulatory submissions, audit readiness, and performance monitoring. In addition, this role supervises and manages the work of clinical quality coordinators, risk adjustment coders, and other quality-related staff, ensuring productivity, accuracy, and adherence to organizational standards. Requirements Job Duties & Responsibilities: • Supervise and manage the work of clinical quality coordinators, risk adjustment coders, and other quality-related staff, including monitoring productivity, accuracy, and compliance with organizational standards. • Provide coaching, training, onboarding, and performance feedback to staff, fostering professional growth and accountability. • Assign and balance workloads for staff, ensuring timely completion of cases, tasks, and reports. • Monitor staff documentation in EZCAP/EZCARE or other systems for accuracy, timeliness, and regulatory compliance. • Conduct periodic quality checks and audits of staff work to ensure accuracy and adherence to requirements. • Track and report on staff productivity metrics; identify trends, address performance issues, and implement improvements to maintain efficiency and quality. • Address escalated issues from staff, providers, and internal departments, resolving routine operational problems and escalating complex issues to the Quality Director or Medical Director as appropriate. • Coordinate and monitor execution of the Quality Improvement Program (QIP), including the QI Program Description, Annual Evaluation, and QI Work Plan. • Track timelines and ensure deliverables are met for HEDIS, Stars, QIPs, CCIPs, and other quality initiatives. • Facilitate the internal Quality Improvement Workgroup, monitoring progress on interventions and supporting cross-departmental initiatives. • Support preparation of Quality Improvement Committee (QIC) and governance committee materials; present findings internally and escalate external reporting to the Quality Director. • Conduct root cause analyses on performance gaps, support corrective action plans and track progress through measurable outcomes. • Oversee quality-of-care grievance intake, tracking, and investigations; ensure timely escalation and resolution. • Collect, validate, and report quality data in collaboration with Data Analysts; prepare draft dashboards, scorecards, and provider reports for leadership review. • Monitor provider performance on quality metrics and assist with dissemination of provider education materials and scorecards. • Coordinate audit readiness activities, including documentation, evidence collection, and submission for HEDIS audits, delegation oversight, and CMS/DHCS reviews. • Act as an operational liaison between Quality and Utilization Management, Case Management, and Population Health teams to ensure coordination of care gap closure and chronic disease improvement initiatives. • Identify recurring performance or compliance issues and escalate trends to the Quality Director for systemic resolution. • Support committee operations by preparing agendas, materials, minutes, and follow-up trackers to ensure accountability for action items. • Support preparation of member and provider communications related to quality initiatives as directed by the Quality Director. • Maintain awareness of regulatory updates and contribute to the translation of requirements into operational workflows. Qualifications: • Bachelor’s degree in nursing, Public Health, Healthcare Administration, or related field. • 3 years of managed care or healthcare quality experience. • Minimum of 2 years of supervisory or people leadership experience. • Knowledge of health plan performance and HEDIS, HOS, CAHPS and CMS Stars measures preferred. • Demonstrated ability to manage staff performance, monitor productivity, and ensure quality deliverables. • Master’s degree (MPH, MHA, MSN, MBA) preferred • Active RN license in California preferred • Certified Professional in Healthcare Quality (CPHQ) preferred • Familiarity with platforms such as Cotiviti, EZCAP/EZCARE, Tableau, or Power BI preferred Job Knowledge, Skills & Abilities: • Strong people leadership skills with the ability to supervise, coach, and evaluate staff. • Skilled in monitoring productivity, conducting quality checks, and ensuring compliance with organizational and regulatory standards. • Excellent organizational and time management skills with the ability to manage multiple priorities. • Ability to interpret and use quality and performance data (HEDIS, Stars, grievances) to inform interventions. • Strong collaboration skills with UM, PHM, and Provider Relations to improve outcomes and close care gaps. • Ability to identify barriers to quality performance and recommend workflow or process improvements. • Adaptable to evolving CMS, DHCS, and NCQA requirements; able to operationalize changes efficiently. • Awareness of health equity and cultural considerations in quality initiatives and provider engagement. • Effective communicator with strong oral and written skills, able to present clearly to staff and leadership. • Strong interpersonal skills with the ability to collaborate across teams, providers, and health plan partners. • High attention to detail, accuracy, and follow-through. • Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint); familiarity with Cotiviti, EZCAP/EZCARE, Tableau, or Power BI preferred.

Responsibilities

The Quality Manager oversees the organization’s Quality Improvement activities, ensuring compliance with regulatory standards and timely completion of deliverables. This role includes supervising staff, conducting audits, and coordinating quality initiatives.