Clinical Quality & Adherence Programs (46741)

ADHEREHEALTH SOLUTIONS LLC•Nashville, TN

About The Position

Clinical Quality & Adherence Programs, Manager is s a clinically focused leader responsible for driving medication optimization and CMS quality measure performance through direct provider outreach, clinical collaboration, and targeted intervention strategies. They will be managing all MCM daily operations, including creating and directing strategies and collaborating with other teams and departments to produce ever increasing results. Responsible for coaching and developing the MCM team to meet and exceed established goals, ensuring adherence to business processes and policies, and creating a positive, competitive, challenging and results-oriented working environment. Provide leadership, direction, guidance, and support to all MCMs in a manner consistent with AdhereHealth core values and business objectives. This role combines hands-on clinical work (including provider discussions and care gap resolution) with operational oversight of clinical staff (e.g., MCMs, MAs) supporting adherence and medication quality initiatives. The manager serves as a clinical subject matter expert across CMS quality measures, with a primary focus on Osteoporosis Management in Women (OMW) and additional medication safety and optimization measures. The manager partners closely with internal clinical, operations, training, and client teams to ensure interventions are clinically appropriate, operationally scalable, and aligned with client performance goals.

Requirements

Associate degree or higher in a healthcare-related field required; Bachelor’s degree preferred.
Clinical background is strongly preferred (e.g., RN, LPN, PharmD, RPh, PA, NP, or equivalent clinical experience).
Proficiency with call center phone systems and outbound dialer technologies.
Proficient in Microsoft Office applications.
Minimum of at least 2–3 years in a leadership, supervisory, or clinical lead role.
Experience in healthcare operations, managed care, or value-based programs preferred.
Prior call center experience is preferred.
Experience with CMS quality measures, medication optimization, or population health programs preferred.
Strong clinical judgment with the ability to apply guidelines in real-world provider settings.
Excellent interpersonal and communication skills, with the ability to build trust and credibility with providers.
Ability to influence without authority and navigate clinical conversations with diverse stakeholders.
Highly organized, process-oriented, and comfortable working across multiple initiatives.
Analytical mindset with the ability to interpret performance data and translate insights into action.
Comfortable operating in a fast-paced, evolving environment with shifting priorities.
Strong interpersonal and communication skills with the demonstrated ability to gain the confidence, respect and trust of providers, senior executives and direct/indirect reports
Superior ability to influence others and manage change to align with strategic direction
Excellent written, verbal and interpersonal communication skills
Highly process oriented with strengths in efficiency and standard operating procedures
Strong leadership, organization, planning and time management skills
Highly skilled at planning, organizing and managing the activities of others
Solid ability to develop, lead, motivate, promote accountability, and engage a diverse workforce
Ability to deal with all situations in a calm and positive manner
Ability to learn new processes quickly in a fast-paced environment
Must be able to take complex problems and distill into manageable pieces to develop solutions

Nice To Haves

Strongly preferred experience in provider outreach, care gap closure, or clinical quality improvement is strongly preferred.

Responsibilities

Manage MCMs to ensure program(s) productivity, quality and consumer satisfaction/client performance objectives are met and performed in an efficient manner
Identify trends in call data for clinical services team and assess patterns and make recommendations to improve operational performance.
Provides operational oversight to support consistent achievement of performance expectations
Prioritize team goals and individual goals to effectively achieve business objectives
Communicate client and company goals and metrics with team members to deliver a high level of customer service and productivity
Supervise and monitor ongoing performance of team members.
Continually examine team performance against department standards and conduct regular performance reviews and one-on-one meetings with direct reports to evaluate performance
Manage special projects
Participate in interviewing, hiring, and training of MCM team members.
Analyzes daily call-center reports and drive daily/weekly/monthly KPI standard
Provide regular feedback to VP Clinical Operations and other members of the management team regarding current operational performance
Manage escalated issues, working with other departments, identifying the root cause and implementing a plan for remediation and presentation of future issues
Collaborate with Health Services Training Team to develop comprehensive training program and maintain training materials to ensure that call center staff receives high quality technical and soft-skills training
Conduct direct provider outreach to discuss and resolve medication-related care gaps, including: Osteoporosis Management in Women (OMW) Guideline-directed therapy in chronic conditions Medication safety initiatives (drug–drug interactions, high-risk medications for falls, inappropriate therapies)
Serve as a clinical liaison with provider offices, presenting evidence-based recommendations in a collaborative, non-directive manner.
Support clinical documentation, provider follow-up, and appropriate closure of care gaps in alignment with CMS and client requirements.
Oversee day-to-day execution of clinical adherence and quality programs, ensuring productivity, quality, and performance targets are met.
Provide functional oversight and clinical guidance to MCMs, and other clinical support staff engaged in medication optimization initiatives.
Identify trends in clinical and outreach data to inform workflow improvements, prioritization strategies, and intervention effectiveness.
Translate quality measure requirements into clear, executable workflows for frontline clinical staff.
Partner with internal stakeholders to refine outreach strategies as measures, client priorities, or regulatory guidance to evolve.
Establish positive partnerships across business groups both inside and outside of the organization
Provide leadership to others through example and sharing of knowledge/skill
Provide strong, dynamic leadership that mentors, develops, and guides MCM staff to achieve overall department success
Coach, mentor, and develop clinical staff through regular one-on-ones, performance feedback, and targeted skill development.
Partner with the AdhereHealth leadership and human resources to execute strategic recruiting and employee engagement programs to attract and retain top performers
Support hiring, onboarding, and training of clinical team members in collaboration with leadership and training partners.
Foster a culture of clinical excellence, accountability, and continuous improvement.
Escalate and resolve complex clinical or provider issues, identify root causes, and implement sustainable solutions.
Collaborate with Training, Quality, Operations, Product, and Client Success teams to ensure alignment between clinical strategy and execution.
Provide regular updates to leadership on program performance, provider engagement trends, risks, and opportunities.
Support special projects and pilot initiatives related to new measures, clients, or care models.