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The Clinical Quality Program Manager is responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business. Primary duties may include, but are not limited to: Leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process. Works with the clinical intervention team to design studies to identify barriers to medical interventions. Ensures that study methodology is sound and appropriate reporting is in place. Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members. Assures compliance with corporate QI work plans. Assures that all QI activities are relevant to the needs of targeted population. Maintains effective documentation of research programs to meet regulatory and Accreditation Standards. Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results. Participates in and provides input to the development of new product designs for major line of business. Oversees the implementation of new initiatives. Leads interactions with regulators or oversight entities. Oversees quality improvement activities for the largest, most complex state programs.
