Imagine360 is seeking a Manager, Clinical Quality and Training to join our team. The Manager, Clinical and Training provides strategic leadership and oversight to the Quality and Training functions serving as a strategic partner to the Medical Management Care Delivery teams. The role will be responsible for leading the day-to-day program execution and developing program strategy for Clinical Quality and Training Services. \n
Position Location: 100% remote\n
Responsibilities include but are not limited to:\n\nSupervisory Responsibilities \n\nClinical Quality Trainer\nClinical Quality and Compliance Specialist Team\n\n\n\n\nDuties\/ Responsibilities \n\nCollaborate with Director, Care360 and Care360 leadership teams regarding service objectives for functional areas of responsibility. \nManages the design, implementation, and oversight of Quality and Training programs, projects and initiatives.\nResponsibility for Quality and Training Services by leading the team and implementing systems and processes that drive continuous quality improvement activities and adhere to URAC accreditation requirements.\nOversight of the training structure in collaboration with clinical or non-clinical program Managers for development and refinement of quality measures and Medical Management programs.\nLeadership and direction to a team to achieve business goals and objectives.\nOversight and maintenance of Medical Management Policy and Procedures related to each specific program with ongoing monitoring of staff adherence and compliance.\nComplete and follow HIPAA training\/PHI guidelines. \nAdhere to internal Medical Management Policy and Procedures, Department of Labor, ERISA, and HIPAA regulations.\nParticipate in presentations and other meetings as needed.\nPerform additional duties as assigned.\nAnalyze data to identify trends and areas for improvement.\nDevelop and maintain quality improvement documentation.\nEnsure accurate and timely reporting of quality metrics.\nPrepare and present reports on quality performance to leadership.\nLead quality improvement meetings and committees (QMC).\nProvide leadership and guidance to staff, including coaching, mentorship, and conflict resolution.\nFacilitate professional growth and skill enhancement for staff in quality management practices.\nStay current with industry best practices and regulatory changes.\n\n\n\n
Required Experience\/Education:\n\nBachelor's degree required in business or healthcare related field. \nGraduate of Accredited School of Nursing, college or university preferred. \n Master's degree preferred.\n10+ years' of experience in healthcare, preferably at a health plan or TPA \n3+ years' of management experience in a health-related field. \nDirect experience in building and leading clinical the quality assurance and the process for national accreditation requirements (i.e. URAC, NCQA). \nDemonstrated success in autonomously leading cross functional teams and projects. \n\n
Licenses or Certifications:\n\nCertification as Professional in Healthcare Quality (CPHQ) preferred.\nCurrent, active, and unrestricted Nursing License preferred. \n\n
Skills and Abilities:\n\nObsession with creating a world-class patient experience and health outcomes \nDemonstrated success motivating and engaging employees and managers to achieve business and program successes. \nAbility to influence clinical leaders as needed to adopt a high level of clinical quality across the organization \nAbility to lead project management and quality improvement initiatives. \nDemonstrate high attention to detail and organizational skills. \nSuperior time management skills and ability to prioritize tasks. \nAbility to communicate professionally and effectively with external vendors, clients, and accrediting bodies. \nExperience with administrative software preferred. \nProblem identification with strong problem-solving skills. \nAbility to manage multiple projects and priorities simultaneously.\nStrong communication and interpersonal skills.\nExperience with data analysis and reporting tools.\nCommitment to continuous improvement and professional development.\n\n
What can Imagine360 offer you?\n\nMultiple Health Plan Options, including employee paid premiums\nCompany paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance\nParental Leave Policy\n20 days PTO to start \/ 10 Paid Holidays\nTuition reimbursement\n401k Company contribution\nProfessional development initiatives \/ continuous learning opportunities\nOpportunities to participate in and support the company's diversity and inclusion initiatives\n\n
Want to see our latest job opportunities? Follow us on LinkedIn\n
Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.\n
Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.\n
**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies\/business partners that have been invited to work on a specific role. Candidate Resumes\/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**\n