Clinical Quality Program Manager

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

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WellSky

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1980

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 Private Equity Round on 2020-07

Healthcare • Consulting • Logistics

WellSky is a leading healthcare technology company dedicated to improving healthcare and community care outcomes worldwide. By offering comprehensive software solutions and analytics, WellSky enables healthcare providers, payers, and community organizations to collaborate and enhance care quality and accessibility. Their focus spans intelligent care management, connected care networks, and transformative analytics, aiming to create more efficient, inclusive, and sustainable healthcare systems. WellSky addresses social determinants of health and emphasizes patient and family engagement, supporting care in various settings including home, long-term, and acute care.

📋 Description

• Ensure compliance with WellSky's Utilization Management and Quality Improvement Program • Serve as a clinical expert on state and federal regulations • Analyze and present data to establish best practices across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities • Facilitate performance measurement and outcomes activities • Ensure compliance with CMS, NCQA, and other regulatory standards • Monitor relevant regulatory changes and support their integration into practices • Generate and validate reports across health plan contracts • Conduct audits of UM decisions, case documentation, turnaround times, and CMS/NCQA requirements • Ensure the UM Program meets NCQA accreditation requirements • Prepare and lead monthly and quarterly committee meetings • Prepare quality reports, analyze trends, and present actionable recommendations to leadership • Support corrective action plans when scoring variances occur • Support quality improvement project initiatives • Prepare for regulatory, accreditation, and contractual audits • Contribute to remediation and documentation of audit findings • Perform other assigned duties

🎯 Requirements

• At least 4-6 years relevant work experience • Experience leading quality improvement projects and committee work • Bachelor's Degree or equivalent work experience • Active, unrestricted license: RN, PT, OT or SLP, with a bachelor’s degree in a related field or a combination of education and experience that includes pertinent clinical experience and advanced working knowledge of CMS standards and guidelines • At minimum, 1-2 years of working knowledge of NCQA UM accreditation standards • Ability to prioritize, plan and handle multiple tasks and demands simultaneously, with competing deadlines • Excellent in manipulating and sorting data for analytics and reporting • Prior experience owning client compliance SLAs and ensuring success in meeting SLA requirements • Willingness to work additional or irregular hours as needed • Must work in accordance with applicable security policies and procedures to safeguard company and client information • Must be able to sit and view a computer screen for extended periods of time • Travel approximately 10% • Applicants for U.S.-based positions must be legally authorized to work in the United States

🏖️ Benefits

• Excellent medical with Rx, dental, and vision benefits • Mental Health support through EAP • Generous paid time off • 13 paid holidays • 100% vested 401(K) retirement plans • Educational assistance up to $2500 per year

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