Manager, Quality Improvement

The Manager, Quality Improvement leads quality and process improvement initiatives across long-term care programs, focusing on operational efficiency, continuous improvement, regulatory compliance, and improved member outcomes.

You will lead Quality and Process Improvement associates and partner across clinical, operational, compliance, systems, and leadership teams to identify opportunities, redesign processes, implement solutions, and monitor results.

Key responsibilities include:

• Leading process improvement initiatives to improve operational efficiency, service quality, compliance, and member outcomes.
• Assessing workflows and business processes to identify gaps, risks, root causes, and improvement opportunities.
• Overseeing quality assurance activities and readiness for regulatory requirements.
• Analyzing quality, compliance, and operational data to identify trends and provide actionable insights.
• Leading cross-functional projects and improvement initiatives.
• Managing corrective actions and process changes resulting from identified quality or compliance gaps.
• Partnering with various teams to develop and implement solutions.
• Overseeing the development and annual review of market policies, procedures, and support tools.
• Monitoring state and federal regulations, industry trends, and contract changes.
• Managing the accurate and timely completion of required state reports.
• Serving as a point of contact for business owners on requests related to processes, policies, reporting, data analysis, and system enhancements.
• Developing and maintaining performance reporting, dashboards, and other tools.
• Researching best practices to establish benchmark data and inform improvement efforts.
• Ensuring associates and care partners are trained on process improvement methods and quality standards.
• Leading, coaching, and developing Quality and Process Improvement associates.

Requirements:

• Bachelor's degree.
• Three or more years of experience leading or supporting healthcare quality improvement or process improvement initiatives.
• Two or more years of formal leadership experience.
• Experience with process mapping, root-cause analysis, workflow assessment, and implementing process or quality improvement initiatives.
• Intermediate to advanced proficiency in Microsoft Office, specifically Excel and PowerPoint.
• Working knowledge and understanding of Power BI.
• Strong analytical skills with experience evaluating quality, operational, or compliance data.
• Strong communication, facilitation, and stakeholder management skills.
• ACHA Level II Background Check is required.

Preferred Qualifications:

• Professional certification such as CPHQ, PMP, or Lean Six Sigma.
• Direct experience working within a Medicare or Medicaid managed care health plan.
• Experience with HEDIS, CAHPS, NCQA, audits, accreditation, or regulatory compliance.

Work Details:

• Remote position.
• Up to 5% travel within Florida for team engagement and collaborative meetings.
• Typical workdays/hours: Monday – Friday; 8:30am– 5:00pm Eastern Time (ET).
• Direct reports: Up to 15 associates.

Compensation:

• Salary range: $86,300 - $118,700 per year.
• Eligible for a bonus incentive plan.