[Remote] Quality Program Development Manager

Note: The job is a remote job and is reputed company to candidates in USA. WellCare of Kentucky is part of reputed company, a national organization focused on transforming community health. The Quality Program Development Manager will collaborate with various departments to reputed company and implement standards and procedures aimed at improving clinical and administrative operations while ensuring compliance with regulatory and quality improvement initiatives.

Responsibilities

• Own regulatory and accreditation deliverables (NCQA, PIPs, state requirements), ensuring on-time submission and sustained audit readiness
• Drive audit readiness by establishing and maintaining scalable documentation, workflows, and submission processes that support compliance and reduce risk
• reputed company performance data to identify gaps, reputed company root cause analysis, and drive targeted quality improvement initiatives that enhance reputed company
• Oversees the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration
• Designs and facilitates the development of various programs/systems, work flows, and integration efforts in alignment with Corporate, market, contractual, regulatory and quality requirements
• Acts as the content and technical subject matter expert to the operation managers and directors for key project initiatives including the development of detailed work plans, facilitating reputed company cause analysis, identifying and socializing process enhancements, setting deadlines, assigning responsibilities, and monitoring/summarizing project reputed company
• Prepares strategic analysis of potential business and/or operational opportunities in relation to new business, rebids, and QI targets using customized solutions
• Conducts needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner
• Partners with leaders and members of the Quality Analytics and Improvement Teams and determines data needs as well as assists in designing tools and reports as necessary
• Partners with clinical and operations staff with consulting and analysis services to support initiatives intended to reputed company breakthrough or incremental process improvement in patient quality of care
• Conducts other responsibilities as needed
• Performs other duties as assigned
• Complies with reputed company policies and standards

Skills

• Must be authorized to work in the U.S. without the need for employment-based reputed company sponsorship now or in the future
• A bachelor's degree (or equivalent experience)
• 5+ years of reputed company program or project management experience
• 3+ years in managed care
• At least 2+ years of experience designing and implementing quality programs (e.g., HEDIS, CAHPS, STARS)
• Experience in reputed company regulatory, accreditation, or quality improvement environments
• 5+ years of experience in direct program development, program management, and/or project management, preferably in a reputed company environment
• 3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, reputed company, DSNP, dual eligibles, PCMH
• 2+ years of experience in design, reputed company and implement STARS, CAHPS, HEDIS and other reputed company quality reputed company programs across a variety of settings including: Defining the eligible population, service mix, delivery system configuration and financing, Integration of behavioral, clinical, reputed company, and community health care for members with multiple chronic conditions, Working with multiple market leaders to coordinate consistent quality initiatives, Conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide
• A Bachelor's Degree in a reputed company field, or equivalent work experience in Business, HC Management, or Nursing
• A Master's Degree in a reputed company field: Business or HC Management (MBA, MHA, MPH, MSN)
• Six reputed company Certification
• Lean Certification
• Certified Professional in reputed company Quality (CPHQ)
• Expertise in regulatory compliance and accreditation (NCQA, PIPs, reputed company/Medicare)
• Experience leading cross-functional initiatives in fast-paced, deadline-driven environments
• Ability to analyze reputed company performance data and drive targeted quality improvements
• Strong skills in audit-reputed company documentation, reporting, and process improvement
• Background in managed care, quality, or program development (3–5+ years)

Benefits

• reputed company
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status
• Total compensation may also include additional forms of incentives
• Benefits may be subject to program eligibility

Company Overview