Quality Improvement Manager

Great Lakes Bay Health Centers • Saginaw, MI

6d • Onsite

About The Position

ESSENTIAL JOB DUTIES

Reasonable accommodations may be made to enable individuals with disabilities to
perform the essential functions.

1. Clinical Quality Measurement and Validation (30%)
Lead the validation of clinical quality measures across GLBHC (UDS, HEDIS,
HRSA, state and health plan measures), confirming that denominator and
numerator logic is applied correctly and reflects actual clinical care
Perform targeted and routine chart reviews to verify data accuracy,
identify documentation gaps, and ensure that EHR workflows support
accurate quality reporting.
Partner with the Quality Data Analyst to review measure definitions,
attribution logic, and population lists; provide clinical interpretation
and feedback to refine reports and dashboards
Investigate discrepancies between reported performance and clinical
expectations; identify root causes and recommend corrective actions
(documentation, coding, workflow, or system changes).
Serve as a subject-matter resource for providers and staff on quality
measure definitions, inclusion/exclusion criteria, and appropriate
clinical documentation.
2. Health Plan Navigation and Value-Based Program Support (25%)
Act as the primary clinical resource for understanding and communicating
payer quality expectations, attribution methodologies, incentive
structures, and benefit designs that affect patient care.
Work with health plans, ACO partners, and state programs to clarify
quality and utilization requirements and translate them into practical
guidance for GLBHC care teams..
Collaborate with Referrals, Care Management/CHWs, Revenue Cycle, and site
leadership to ensure alignment between health plan requirements, access
workflows, and care-management activities.
Monitor payer rosters, gaps-in-care lists, and performance reports;
validate accuracy and coordinate follow-up with sites to address
identified care gaps.
Support GLBHC’s participation in value-based contracts by helping clinical
teams prioritize high-impact measures, high-risk populations, and targeted
outreach strategies.
3. Clinical Practice Support and Performance Improvement (25%)
Partner with providers and site managers to design and implement clinical
workflows that support quality measures, and care-gap closure
Lead or co-lead focused quality improvement projects (PDSA cycles) that
address clinical outcomes, preventive care, chronic disease management,
and patient experience.
Provide one-on-one and group coaching to providers and care teams on
documentation standards, coding related to quality measures, and effective
use of EHR tools and registries.
Participate in clinical huddles, site meetings, and multidisciplinary
teams as the QI representative; bring forward data, highlight
opportunities, and support problem-solving.
Identify training needs and collaborate with Clinical Training and
Development team to develop and deliver targeted education on quality
workflows and tools.
4. Team Leadership, Supervision, and Staff Development (10%)
Directly supervise the Quality Data Analyst and outreach staff responsible
for patient outreach, panel management, and quality campaigns (e.g.,
recalls, screenings, chronic disease follow-up)
Provide clear expectations, regular feedback, and timely Career
Development Reviews for assigned staff.
Prioritize and assign analytic and outreach work in alignment with
organizational quality goals and payer program requirements.
Support staff development through coaching, cross-training, and
opportunities to participate in improvement projects and committees.
Foster a collaborative, patient-centered, and data-informed team culture
focused on closing care gaps and improving outcomes.
5. Reporting, Communication, and Compliance (10%)
Assist the Quality Improvement Director in preparing internal and external
quality reports for leadership, health plans, regulatory agencies, and
grantors.
Communicate measure performance, care-gap trends, and improvement
priorities to providers and site leadership in a clear, concise, and
actionable manner.
Support preparation for audits, site visits, and accreditation or
recognition activities related to clinical quality (e.g., HRSA, Grants,
state programs).
Ensure that QI activities, data handling, and outreach workflows meet
regulatory and organizational standards for privacy, safety, and clinical
quality.

Note:  This job description is not designed to cover or contain a comprehensive
listing of activities, duties or responsibilities that are required of the
employee for the job.  Duties, responsibilities and activities may change at any
time with or without notice.

MARGINAL JOB DUTIES

1. Communicate with appropriate staff to improve processes with regards to EMR
documentation and coding needs.
2. Construct site and program activities to help improve quality care. Provide
educational information to center managers and providers.
3. Performs other duties as assigned.

Requirements

• Active, unrestricted Registered Nurse (RN) license in the State of Michigan is required.
• Minimum of five (5) years of combined experience in ambulatory or primary care clinical practice, population health, care management, and clinical quality improvement, with demonstrated responsibility for quality measures, data validation, and workflow improvement required.
• Current, unrestricted RN license in the State of Michigan preferred/required per discipline.
• Minimum of five years of experience in ambulatory or primary care clinical practice, population health or care management.
• At least two years experience in clinical quality improvement, including familiarity with UDS, HEDIS, or similar measure sets.
• Experience working with health plans, ACOs, or value-based payment programs.
• Strong understanding of clinical quality measures, documentation standards and basic coding principles relevant to quality reporting.
• Ability to interpret and validate data reports, identify trends, and translate findings into practical clinical actions.
• Demonstrated skills in project management, organization, and follow-through, with the ability to manage multiple priorities simultaneously.
• Able to build effective working relationships with Physicians, Advance Practice Providers, Nurses, Medical Assistants, behavioral health staff, outreach staff, and administrative personnel.
• Comfortable facilitating discussions, giving feedback, and supporting change in a respectful and collaborative way.
• Ability to navigate differing perspectives between health plans, and clinical teams.
• Light, exerting up to 10 pounds frequently
• Full-time.
• Flexible and varied.
• Position is not eligible for remote or hybrid status
• Frequent, weekly travel within service areas, some out-of-area travel.

Nice To Haves

• Bachelor’s degree or higher in Nursing preferred.
• Formal education, certification, or specialized training in quality improvement, population health, clinical quality measurement, or healthcare data analytics.

Responsibilities

• Clinical Quality Measurement and Validation
• Health Plan Navigation and Value-Based Program Support
• Clinical Practice Support and Performance Improvement
• Team Leadership, Supervision, and Staff Development
• Reporting, Communication, and Compliance
• Communicate with appropriate staff to improve processes with regards to EMR documentation and coding needs.
• Construct site and program activities to help improve quality care.
• Provide educational information to center managers and providers.
• Performs other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees