Quality Care Manager
About The Position
We are seeking a Quality Care Manager to support Capital Health Plan's clinical quality, patient safety, and performance improvement efforts. This role analyzes qualitative and quantitative data, conducts clinical reviews, and prepares reports related to performance measures, quality outcomes, and patient safety. The Quality Care Manager plays a key role in coordinating peer review activities, conducting medical record reviews, supporting quality audits, and ensuring compliance with NCQA, CMS, and State of Florida requirements. This position also serves as a resource across the organization by providing consultation on quality improvement, best practices, accreditation standards, and performance measurement initiatives.
Requirements
- Bachelor's degree in nursing or a bachelor's degree in a clinical field from an accredited four-year college or university
- Clinical licensure in the State of Florida
- Minimum of three years of experience working in a clinical healthcare setting
- Experience conducting clinical reviews, audits, or quality investigations
- Ability to analyze and interpret qualitative and quantitative clinical data
- Strong written and verbal communication skills, including preparation of reports and presentations
- Ability to coordinate and maintain documentation to support accreditation and regulatory compliance
- Proficiency with computer applications, including word processing, spreadsheets, databases, and web-based tools
Nice To Haves
- Experience with quality improvement programs, performance measurement, or accreditation activities
- Familiarity with NCQA standards, CMS Part C and D requirements, and state regulatory requirements
- Experience conducting peer review activities or quality of care investigations
- Strong data analysis and reporting experience related to clinical outcomes and patient safety
- Ability to manage complex quality projects and meet regulatory reporting deadlines
- Certified Professional in Healthcare Quality (CPHQ)
Responsibilities
- Analyze qualitative and quantitative data
- Conduct clinical reviews
- Prepare reports related to performance measures, quality outcomes, and patient safety
- Coordinate peer review activities
- Conduct medical record reviews
- Support quality audits
- Ensure compliance with NCQA, CMS, and State of Florida requirements
- Provide consultation on quality improvement, best practices, accreditation standards, and performance measurement initiatives
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
101-250 employees
