Clinical Quality Manager RN

Job Summary

A company is looking for a Clinical Quality Program Manager.

Key Responsibilities:

• Facilitate performance measurement activities and ensure compliance with CMS, NCQA, and other regulatory standards
• Generate and validate reports to monitor performance across health plan contracts
• Conduct regular audits of UM decisions and prepare detailed quality reports with actionable recommendations

Required Qualifications:

• At least 4-6 years of relevant work experience
• Experience leading quality improvement projects and committee work
• Bachelor's Degree or equivalent work experience
• Active, unrestricted clinical license (RN, PT, OT, or SLP) preferred
• 1-2 years of working knowledge of NCQA UM accreditation standards preferred