Clinical Quality Management Director
1 week ago
Cambia Health Solutions is seeking a highly skilled Clinical Quality Management Director to join our team. As a key member of our organization, you will be responsible for developing and overseeing an effective clinical quality management/assurance program, including quality management strategies, policies, monitoring, and reporting.
Key Responsibilities- Develop and implement quality management strategies to ensure compliance with regulatory requirements and internal standards.
- Monitor and analyze performance data to identify areas for improvement and develop corrective action plans.
- Collaborate with stakeholders to identify and mitigate risks, error-proof systems, and uphold compliance standards.
- Develop and maintain policies and procedures related to quality management functions.
- Champion a culture of ethics, integrity, and compliance throughout the organization.
- Bachelor's degree in a related field (e.g., healthcare administration, healthcare policy, nursing, pharmacy, industrial engineering) or equivalent experience.
- 5+ years of experience in quality management, internal audit/compliance, or process consulting in a highly regulated industry (e.g., healthcare, finance, power).
- 3+ years of experience working in managed care health insurance industry. Utilization management experience required.
- Training or certification in quality improvement (e.g., CQM, CQA, Lean Six Sigma, ISO).
- Knowledge base of clinical standards of care, medical policy, coding, NCQA, CMS, and other relevant state regulatory agency requirements.
- Masters degree in a related field.
- Proven leadership skills with ability to motivate teams and facilitate large-scale change.
- Excellent analytical skills with the ability to assess complex business processes and data sets.
- Strong program management skills with demonstrated ability to focus activities aligned with strategic priorities and to develop tactical plans, drive performance, and achieve targets.
Cambia Health Solutions is a purpose-driven organization built on trust and innovation. We are committed to creating a person-focused and economically sustainable healthcare system. Our team is dedicated to helping members live healthy lives, and we offer a competitive salary and benefits package, as well as opportunities for growth and development.
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