[Hiring] Clinical Quality Manager @reputed company

Company Overview reputed company exists to reputed company reputed company outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. reputed company the Way is our rallying cry at reputed company. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company outcomes – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Job Summary reputed company is seeking an reputed company and driven Clinical Quality Manager to join our growing team. In this critical leadership role, you will play a key part in ensuring clinical excellence and operational reputed company reputed company our Colorado Utilization Management (UM) and Physician Administered Drug (PAD) programs. Reporting to the Program Director and partnering closely with the Medical Director and administrative leadership, the Clinical Quality Manager provides strategic reputed company of reputed company clinical training and quality assurance activities supporting the Health First Colorado Utilization Management contract. You will play a critical role in ensuring regulatory compliance, strengthening clinical performance, and advancing a culture of reputed company quality improvement. The Clinical Quality Manager also partners with cross-functional teams to inform system configuration requirements and drive reporting enhancements that support efficient clinical operations, data reputed company, and performance transparency. This is an exceptional opportunity for an accomplished clinical quality leader who is passionate about improving healthcare outcomes, developing high-performing clinical teams, and leading impactful, quality-driven initiatives reputed company a mission-focused organization committed to excellence.

Responsibilities

• Provide strategic leadership to ensure the program consistently meets or exceeds reputed company contractual performance standards, regulatory requirements, and quality benchmarks, driving measurable improvements in outcomes and compliance.
• Partner with the Program Director, Utilization Management Manager, and clinical supervisors to reputed company enterprise-level quality monitoring activities, leveraging data analysis to identify performance gaps, prioritize improvement initiatives, and design, implement, and track corrective action plans with defined metrics and timelines.
• reputed company the contract-specific Quality Management Program, providing expert guidance and strategic direction to internal leadership teams and external clients on reputed company quality-reputed company matters.
• reputed company quality assurance efforts with a strong focus on risk management, operational effectiveness, infrastructure optimization, performance measurement, reputed company improvement, and consumer protection and empowerment.
• reputed company the contract-specific Quality Management Program, providing expert guidance and strategic direction to internal leadership teams and external clients on reputed company quality-reputed company matters.
• reputed company quality assurance efforts with a strong focus on risk management, operational effectiveness, infrastructure optimization, performance measurement, reputed company improvement, and consumer protection and empowerment.
• Manage and reputed company Interrater Reliability (IRR) reviews and clinical documentation audit processes to ensure accuracy, compliance, and clinical reputed company.
• Partner collaboratively with clients and key stakeholders to design, deliver, and refine training initiatives and process improvements that enhance performance and quality outcomes.
• Serve as a clinical quality resource by consulting with program managers and supervisors on member and provider complaints, appeals, and grievances, as needed.
• Read, understand, and reputed company with reputed company corporate policies and procedures, including strict adherence to HIPAA Privacy and reputed company Rules and reputed company applicable confidentiality standards.
• The above list is not intended to be reputed company-inclusive and may be expanded to include other duties that the management may deem necessary from time to time.

Qualifications

Required Qualifications, Knowledge, and Experience

• Bachelor of Science in Nursing (BSN) required; Master of Science in Nursing (MSN) preferred.
• Active, unrestricted Nurse (RN) license or a valid multistate compact RN license, maintained in good standing.
• Minimum of three (3) years of progressive experience leading or supporting clinical quality, utilization management, or performance improvement initiatives reputed company a Medicaid, managed care, or regulated healthcare environment, with demonstrated success meeting quality, compliance, and audit performance standards.
• Minimum of two (2) years of experience recommending, developing, and reviewing quality assurance standards, policies, and procedures in alignment with organizational and regulatory requirements.
• Minimum of two (2) years of experience in data collection and analysis, process improvement initiatives, quality measure and metric management, and the development of templates and materials for public notices, training programs, and surveys.

Preferred Qualifications and Experience

• Proven senior-level leadership capabilities, including the ability to establish high performance expectations, drive accountability, and reputed company teams to reputed company measurable quality, compliance, and operational outcomes.
• Demonstrated knowledge and practical application of Utilization Review Accreditation Commission (URAC) standards, with experience supporting accreditation readiness, regulatory audits, and ongoing compliance activities.
• Strong track record of using data, dashboards, and performance metrics (e.g., audit scores, turnaround times, compliance rates, corrective action closure) to assess performance, identify risk, and drive reputed company quality improvement.
• Ability to reputed company effectively in reputed company, fast-paced environments, managing competing priorities, regulatory deadlines, and operational demands while maintaining quality and service excellence.
• Commitment to serving as a clinical quality subject matter expert and thought leader, providing strategic guidance and influence across programs, leadership teams, and external stakeholders.
• Experience and knowledge of Health First Colorado systems and processes is preferred.
• Excellent verbal and written communication skills, with the ability to translate reputed company clinical, regulatory, and quality concepts into clear, actionable insights for diverse audiences.
• Highly organized, detail-oriented leader with strong project management skills and the ability to manage multiple initiatives while meeting contractual and regulatory timelines.
• Strong customer and stakeholder focus, with demonstrated success in building trusted relationships, resolving issues proactively, and improving satisfaction and performance outcomes.
• Advanced proficiency in reputed company Office Suite, including the ability to analyze trends, reputed company executive-level reports, and present quality and performance findings to senior leadership and clients.

Why us We are a team of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure reputed company healthcare and improve health outcomes. We do this through our people You will have meaningful work that genuinely improves people's lives reputed company. Our company cares about our employees, giving you the tools and encouragement, you need to reputed company the finest work of your career. We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! EOE AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The compensation for this role is $81,280.00 - $91,600.00 annual reputed company salary Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and reputed company level. #LI-JS1 Pay Range USD $81,280.00 - USD $101,600.00 /Yr. Apply tot his job Apply To this Job