Clinical Quality Advisor

Altais•San Francisco, CA

9d•$107,000 - $128,500

About The Position

The Clinical Quality Advisor directs and manages multi-departmental and cross-functional programs and projects, supports quality improvement initiatives, analyzes performance data, and develops improvement activities based on industry best practices. The role develops and implements departmental or cross-functional projects and initiatives, ensuring timely delivery and continuous improvement, and interfaces with internal and external customers on technical matters and program status to enhance delivery and efficiency. The position supports improvement efforts across measures and programs including CMS Star Ratings, HEDIS, CAHPS, HOS, P4P, CMS quality withhold, MCAS, and NCQA Quality Improvement standards. It researches evidence-based practices, benchmarks, and industry standards; monitors outcomes; translates complex data into recommendations; prepares reports and presentations; and supports training, audits, governance, and cross-functional committees. The role independently manages projects under limited supervision, tracks milestones and delivery plans, and provides guidance, coaching, and training to others. The anticipated salary range is $107,000–$128,500 per year. Altais offers medical, vision, and dental coverage, a 401(k) savings plan with company match, flexible time off, and nine paid holidays. External hires must pass a background check and drug screen.

Requirements

Bachelor’s degree or equivalent experience.
At least 8 years of relevant experience in managed care quality improvement, care management, or clinical program management in a clinical or healthcare environment.
Experience with Managed Service Organization (MSO)/Independent Practice Association (IPA) or health plan population health management or quality.
Working knowledge of HEDIS, CAHPS, HOS, CMS Medicare Star Ratings, P4P programs, CMS quality withhold, Managed Care Accountability Set (MCAS), and NCQA Quality Improvement standards.
Specific licensing requirements may apply, such as LVN, RN, NP, PA, MSW, or CPhT.

Responsibilities

Collaborate with team members to develop targeted improvement activities based on outcomes and industry best practices, with a focus on performance measures such as CMS Star Ratings, HEDIS, CAHPS, HOS, and P4P.
Research evidence-based practices, national and regional benchmarks, and industry standards, and integrate findings into quality improvement initiatives.
Monitor improvement activities through routine analysis of measure outcomes and provide actionable feedback to management.
Use and implement performance improvement methodologies, including rapid-cycle improvement approaches.
Participate in developing and maintaining annual quality improvement program documents and evaluations.
Support the development, updating, and delivery of quality improvement training and problem-solving tools for teams and stakeholders.
Support intradepartmental quality improvement teams, programs, projects, and initiatives.
Identify opportunities to improve the delivery and efficiency of external-facing quality improvement initiatives through technology and process improvements.
Translate complex data into meaningful findings and recommendations for departmental stakeholders and the Quality Improvement Leadership Team.
Prepare reports, conduct data analysis, and create materials for committees and management.
Contribute to continuous improvement of programs and processes, set and achieve operational targets, and recommend system or process enhancements.
Monitor programs from initiation through delivery and organize interdepartmental activities to meet schedules and budgets.
Represent programs in governance and interdepartmental forums; define and track milestones and maintain and report on integrated delivery plans in accordance with company methodology standards.
Independently manage projects under limited supervision and solve complex problems involving multiple issues or specialties.
Communicate with internal and external parties, influence operational policies and practices, and provide guidance, coaching, and training to employees; manage projects and delegate and review work as needed.
Serve as a subject matter expert and regularly brief key stakeholders on initiatives.
Lead and participate in cross-functional committees and external stakeholder workgroups supporting quality improvement initiatives.
Participate in audits as required and contribute to corrective processes that meet audit requirements and improve clinical performance, quality, and care management.