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Clinical Quality Management Director
1 month ago
Clinical Quality Management Director
Cambia Health Solutions is seeking a Clinical Quality Management Director to lead our clinical quality management programs. As a key member of our team, you will be responsible for developing and implementing effective quality management strategies, policies, and procedures to ensure compliance with regulatory requirements and internal standards.
Key Responsibilities:
- Develop and oversee clinical quality management programs to ensure compliance with regulatory requirements and internal standards.
- Analyze performance data to identify opportunities for improvement and develop strategies to address gaps in care.
- Collaborate with stakeholders to identify and mitigate risks, error-proof systems, and uphold compliance standards.
- Develop and implement quality assurance functions, including audits of systems, work processes, and clinical determinations.
- Partner with shared services to implement improvements through workflow processes, training, and technical improvements.
Requirements:
- Bachelor's degree in a related field required (e.g., healthcare administration, healthcare policy, nursing, pharmacy, industrial engineering).
- 5+ years in a quality management, internal audit/compliance, or process consulting role in a highly regulated industry (e.g., healthcare, finance, power).
- 3+ years of 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.
About Cambia Health Solutions:
Cambia Health Solutions is a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.
Why Join the Cambia Team?
At Cambia, you can:
- Work alongside diverse teams building cutting-edge solutions to transform health care.
- Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
- Grow your career with a company committed to helping you succeed.
- Give back to your community by participating in Cambia-supported outreach programs.
