Manager of SoonerSelect Quality

State of Oklahoma•Oklahoma City, OK

13d•Onsite

About The Position

The Manager of SoonerSelect Quality is responsible for day-to-day operational and technical oversight of quality activities for the SoonerSelect managed care program. The role supports oversight of contracted Managed Care Entities (MCEs), including medical plans, the Children’s Specialty Program (CSP), and Dental Benefit Plans (DBPs). It works closely with the SoonerSelect Quality Director to translate quality strategy into consistent monitoring, follow-up, and measurable improvement. The position reviews quality reports, monitors performance, oversees Performance Improvement Projects (PIPs), manages member and provider experience survey activities, coordinates and monitors the External Quality Review Organization (EQRO), and supports the Quality Advisory Committee (QAC) and its subcommittees. It also analyzes and communicates quality findings, makes recommendations, and engages internal and external stakeholders. The role is based at the OHCA office in Oklahoma City; being present at the office is an essential function. Work is typically performed in an office setting, and job-related travel is required.

Requirements

Master’s degree and 2 years of professional experience, or bachelor’s degree and 3 years of professional experience, or an equivalent combination of education and experience, substituting one year of professional-level experience for each year of required education.
Strong knowledge of Medicaid managed care quality, quality improvement methodologies, performance measurement, data analysis, regulatory and contractual requirements, and program oversight.
Skills in data analysis, problem-solving, report development, and team supervision.
Ability to synthesize trends, apply regulatory standards, communicate with technical and non-technical audiences, conduct critical analysis and report review, monitor projects and contracts, and engage stakeholders.
Clear written and verbal communication skills.
Ability to complete job-related travel.
Willingness to work in person at the office; office presence is an essential function.
Application must include a resume/CV with complete work and education history.

Nice To Haves

Clinical license, such as RN, LPN, LPC, or LCSW, particularly with experience evaluating provider performance or quality-related compliance.
Experience in managed care or Medicaid program administration.
Demonstrated success in stakeholder engagement or vendor management.
Experience in compliance, auditing, or contract oversight.
Supervisory or leadership experience.
Project or change management certification.
Experience with Medicaid managed care quality, quality improvement, performance measurement, HEDIS/CMS Core Set measures, or health care quality reporting.
Experience reviewing Performance Improvement Projects, quality reports, corrective actions, or other formal quality improvement activities.
Experience with External Quality Review Organization activities, vendor management, contract monitoring, or deliverable review.
Experience analyzing health care quality data, survey results, performance measures, trends, and outcomes.
Experience engaging managed care entities, providers, members, committees, vendors, or other internal and external stakeholders.
Project management or change management experience.
Master’s degree, clinical license, or quality-related certification in a related field.

Responsibilities

Manage and coordinate day-to-day quality oversight activities for SoonerSelect MCEs, including medical plans, CSP, and DBPs.
Review required MCE and DBP quality reports submitted through MCI and other reporting mechanisms; identify deficiencies, trends, and improvement opportunities, and coordinate follow-up.
Monitor quality performance using data from MCI, CORETechs, quality scorecards, survey results, MCE reports, and EQRO findings; identify trends, outliers, gaps, and progress toward targets.
Manage and support PIP oversight with the EQRO, including review of methodology, measures, interventions, progress, barriers, outcomes, sustainability, findings, and recommendations.
Manage CAHPS member experience and Provider Satisfaction Survey activities, including partner or vendor coordination, results review and analysis, reporting, trend identification, and development and monitoring of data-driven improvement activities.
Support EQRO oversight and contract monitoring, including review of deliverables, project activities, reports, invoices, timelines, and contract performance, and follow up on identified concerns.
Support the SoonerSelect QAC and its subcommittees by coordinating materials, presenting or supporting presentations of quality data and reports, facilitating PIP and quality improvement discussions, and tracking recommendations and action items through resolution.
Serve as a subject matter expert and liaison with MCEs, DBPs, the EQRO, OHCA program areas, providers, members, and other stakeholders on quality reporting, performance measures, PIPs, quality improvement expectations, and related requirements.
Prepare analyses, summaries, reports, presentations, and recommendations for the SoonerSelect Quality Director, Chief Quality Officer, agency leadership, QAC, and other stakeholders.
Reprioritize work as needed in response to emerging quality concerns, regulatory requirements, leadership priorities, and MCE performance.
Perform other duties as assigned.