Manager, Clinical Education & Quality

Personify Health • , CA

1d • $91,520 - $106,000 • Remote

About The Position

The Care Management Manager of Education & Quality is responsible for the development, implementation, and ongoing oversight of regulatory compliance, quality assurance, and training programs across Care Management functions, including Utilization Management (UM), Case Management (CM), and Population Health/Disease Management. This role ensures clinical and non-clinical staff are equipped to meet state and federal regulatory requirements, accreditation standards (NCQA, URAC), and organizational expectations, while supporting operational excellence and continuous quality improvement. The role has different levels: Level I focuses on operational compliance and training, Level II focuses on program and advisory aspects, and the Senior Level provides enterprise-level strategic leadership for Care Management compliance, quality, and education strategy, ensuring programs remain continuously audit-ready and leading regulatory interpretation and organizational response planning.

Requirements

• Basic computer literacy
• The ability to work on multiple screens, and proficient typing skills.
• Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
• Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
• Ability to work independently and utilize written resources to problem solve.
• After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in: Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet—there may be additional programs as it relates to particular job duties
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Excellent verbal and written communication skills for upward and downward conversations
• Working knowledge of managed care operations and Care Management workflows
• Understanding of NCQA, URAC, CMS, ERISA, and state regulatory basics
• Attention to detail and strong documentation skills
• Effective verbal and written communication
• Proficiency with required systems and tools
• Advanced understanding of Care Management regulatory and accreditation requirements
• Strong analytical and problem-solving skills
• Ability to translate complex regulations into operational guidance and training
• Project management and prioritization skills
• Confidence presenting and advising leaders
• Expert-level regulatory and accreditation knowledge
• Strategic thinking and systems-level problem solving
• Executive presence and influence
• Proven ability to scale compliance and training programs
• Strong leadership, mentoring, and change management capabilities
• Active, unrestricted Registered Nurse (RN) license required
• Minimum 2–4 years of experience in managed care, Care Management, UM, or quality/compliance support
• Minimum 4–6 years of experience in Care Management compliance, quality, UM/CM, or training
• Demonstrated experience leading audits, training programs, or quality initiatives
• Bachelor’s degree required; advanced degree preferred
• 6+ years of progressive leadership experience in managed care compliance, quality, and training
• Deep experience with NCQA/URAC surveys, CMS alignment, and multi-state regulatory oversight
• Proven leadership and strategic program development experience
• Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance.
• Ability to sit for 6-8 hours.
• Constant use of computer keyboard and mouse; repetitive use of both hands.
• Occasional to frequent twisting of neck; occasional bending of neck and at waist.

Nice To Haves

• Experience delivering or supporting staff training preferred
• Bachelor’s degree preferred
• Relevant certifications preferred (CPHQ, CCM, etc.)

Responsibilities

• Support execution of established compliance, audit, and quality monitoring activities within Care Management programs.
• Conduct routine file audits, training audits, and quality reviews using standardized tools.
• Track, document, and report audit findings, corrective actions, and follow-up activities.
• Ensure training, quality, and audit documentation meets regulatory and accreditation requirements.
• Apply state, federal, NCQA, URAC, CMS, and ERISA requirements under supervision.
• Deliver training using established curricula for clinical and non-clinical staff.
• Assist with onboarding education and ongoing refresher training.
• Apply adult learning principles to support learner engagement and retention.
• Maintain training records, attendance logs, and competency documentation.
• Collaborate with Care Management leaders, trainers, and compliance staff on implementation activities.
• Escalate risks, gaps, or trends appropriately.
• Lead compliance monitoring activities across UM, CM, and population health programs.
• Interpret regulatory and accreditation requirements and translate them into operational guidance, tools, and workflows.
• Manage internal audits and support external audits, including preparation of evidence files and corrective action plans.
• Analyze trends from audits, complaints, and quality data to identify systemic risk and improvement opportunities.
• Serve as a subject matter expert for Care Management regulatory requirements.
• Design, implement, and evaluate formal training programs using multiple modalities (virtual, self-paced, live, 1:1).
• Conduct training needs assessments and gap analyses.
• Measure training effectiveness and adjust curricula based on outcomes and quality findings.
• Provide consultation to operational leaders on compliance, quality, and training strategies.
• Participate in Quality Improvement Committee (QIC) activities as assigned.
• Mentor staff and contribute to skill development within the training/compliance team.
• Provide enterprise-level leadership for Care Management compliance, quality, and education strategy.
• Ensure Care Management programs remain continuously audit-ready.
• Lead regulatory interpretation, impact assessment, and organizational response planning.
• Oversee development and annual evaluation of the Quality Management Program components related to Care Management.
• Represent Care Management in enterprise compliance initiatives and accreditation engagements.
• Establish long-term training and competency frameworks aligned with organizational growth, automation, and regulatory change.
• Drive innovation in training delivery, measurement, and scalability.
• Ensure training programs support quality outcomes, staff readiness, and member experience.
• Lead and develop the compliance and training team, including performance management and succession planning.
• Advise senior leaders, Medical Directors, and executives on compliance risk, quality performance, and readiness.
• Foster a culture of continuous learning, accountability, and improvement.

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions
• Unlimited PTO
• Mental health support
• Retirement planning
• Financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

What This Job Offers

• Job Type: Full-time
• Career Level: Manager