Sustained Quality Jobs (NOW HIRING)

As our Manager, Clinical Quality Improvement, you will lead a team of dedicated LVNs/RNs in support of organizational quality improvement initiatives across Medicare, Medicaid and Commercial space. You will partner with other departments, health plans and providers to develop and monitor quality improvement plans, and report out to leaders. This position offers the opportunity to not only engage at the local level, but also engage at a system/national level in the population health space.

Every day you will negotiate project timelines, coordinate action plans, and analyze results to align with strategic goals. Collaboration is key, as the Manager will work with medical groups and health plans, establishing and maintaining quality improvement programs.  You will also lead QI committees, ensure compliance with regulatory standards (DMHC, DHCS, CMS, NCQA), and manage QI documentation like the Work Plan, Program Description, and Annual Evaluation. You will identify and address programmatic weaknesses through Corrective Action Plans, driving ongoing improvement.  The position also involves data analysis in collaboration with IT, defining outcome benchmarks, and developing performance dashboards. Oversight of critical programs such as HEDIS submissions, CMS Stars, and Pay for Performance is essential. You will lead, develop, and present to senior leadership, managing both office-based and remote QI staff.

To be successful in this role, you must have a proactive approach to drive change and ensure sustained quality across all clinical operations.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

This position is work from home within California.

• Provides leadership and facilitation of QI Committees or workgroups.
• Provides expertise in the interpretation, implementation, and maintenance of regulatory standards (e.g., DMHC, DHCS, CMS, NCQA).
• Creates or updates Policies and Procedures to ensure compliance with regulatory requirements.
• Manages and updates the QI Trilogy documents - QI Work Plan, Annual Program Description and Annual Evaluation.
• Performs oversight through periodic reviews and reporting of key performance indicators.
• Identify programmatic weaknesses and performance gaps. Implement Corrective Action Plans and remediate identified deficiencies.Leads the identification of improvement opportunities and solutions to improve quality.

Required:

• Five (5) years of Quality Management experience in managed care health plan setting or medical group
• Five (5) years of oversight in a manager or lead capacity of clinical and non-clinical quality management staff
• Three (3) years HEDIS measures reporting and experience in CMS Stars, P4P, ACO and Value Based Payment Programs
• Three (3) years Medical record review project management
• Bachelors degree or equivalent in health sciences or related field
• Clear and current CA Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license
• Knowledge of quality improvement tools and methodology, such as PDSA, Lean, Six Sigma, and Statistical Process Control Analysis
• Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes
• Strong communication and presentation skills, training/meeting facilitation skills a plus
• Strong team building and interpersonal skills
• Ability to utilize sound judgment and promptly report potential risks

Preferred:

• Two (2) years of clinical experience in an acute care setting, long term care facility or home health care preferred
• Masters degree preferred
• Certified Professional in Healthcare Quality (CPHQ) or Certified Mastered Black Belt or Lean Six Sigma Black Belt Certification or Six Sigma Black Belt preferred
• Experience with medical risk adjustment preferred

#LI-DH

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
One Community. One Mission. One CaliforniaÂ

Required:

• Five (5) years of Quality Management experience in managed care health plan setting or medical group
• Five (5) years of oversight in a manager or lead capacity of clinical and non-clinical quality management staff
• Three (3) years HEDIS measures reporting and experience in CMS Stars, P4P, ACO and Value Based Payment Programs
• Three (3) years Medical record review project management
• Bachelors degree or equivalent in health sciences or related field
• Clear and current CA Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license
• Knowledge of quality improvement tools and methodology, such as PDSA, Lean, Six Sigma, and Statistical Process Control Analysis
• Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes
• Strong communication and presentation skills, training/meeting facilitation skills a plus
• Strong team building and interpersonal skills
• Ability to utilize sound judgment and promptly report potential risks

Preferred:

• Two (2) years of clinical experience in an acute care setting, long term care facility or home health care preferred
• Masters degree preferred
• Certified Professional in Healthcare Quality (CPHQ) or Certified Mastered Black Belt or Lean Six Sigma Black Belt Certification or Six Sigma Black Belt preferred
• Experience with medical risk adjustment preferred

#LI-DH