Healthcare Careers

THE HEALTHCARE INITIATIVE

Where Talent Meets Opportunity

Director of Quality (Managed Care)

California

Position:

A progressive and growing Healthcare organization looking for a Director of Quality to oversee the Quality, credentialling, grievances and appeals areas of the health organization.   Provides strategic direction of the quality functions consistent with contractual and regulatory requirements, and the organizations strategies and objectives.  Collaborates with internal departments to ensure that the Quality program meets or exceeds NCQA and regulatory standards.  Maintains working relationships with DHCS and DMHC. Develops and manages the departmental budget. Reports directly to the Associate Chief Medical Officer and partners with the Medical Director.

Position Type/Expected schedule:

• Hybrid work environment: Remote/ office /site reviews at healthcare facilities.
• Monday-Friday work schedule

Qualifications:

• Bachelor’s degree in nursing, Business Management, or related field,
• Master’s degree in nursing,
• Unrestricted California Registered Nurse license, required.

• 5+ years of experience in quality and/or disease management in a healthcare setting, required.
• 5+ years of supervisory experience in a healthcare setting, preferred.
• Recent experience working in a managed care setting, preferred
• Experience working with Medi-Cal and/or Medicare populations, strongly preferred
• Valid California driver license and reliable transportation required.
• Working knowledge of HEDIS Process, NCQA standards and accreditation activities, strongly preferred.

Key Skill Set:

• Organized
• Mentor
• Effective communication skills both written and verbal.
• Discreet/confidential
• Analytical

Location:

This location offers many outdoors areas to explore and enjoy while being centrally located to re-known universities, a wide variety of sporting events, a variety of museums and some of the best dining in the United States.

We look forward to an opportunity to speak to you. To apply or schedule a confidential phone conversation, please send your resume (MS WORD format preferred) to

alison@thi-search.com or call 720-735-9739