Clinical Quality Manager RN

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