Work from home within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team of Transformation, Quality, & Learning leaders are living our mission to make health care easier and lives better. As a member of the Transformation, Quality, & Learning team, our Manager Clinical Quality Management & Compliance directs and manages the activities of a clinical quality programs team. This position oversees staff and provides leadership and direction to ensure operational and procedural compliance with regulatory requirements for Health Care Services in addition to maintaining enterprise-wide accreditation. The Manager Clinical Quality Management & Compliance represents the department in interactions with all levels of management, vendor partners, providers and outside consultants. - all in service of creating a person-focused health care experience. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.
Are you a seasoned healthcare professional with a passion for ensuring exceptional clinical quality and regulatory compliance? Do you have a knack for leadership and a talent for driving operational excellence? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Bachelor's degree in a related field required (e.g., healthcare administration, healthcare policy, nursing, pharmacy, industrial engineering) Masters degree in related field preferred.
5+ years in a quality management, internal audit/compliance, or process consulting role in a highly regulated industry (e.g., healthcare, finance, power).
3+ years of working in managed care health insurance industry. Utilization management experience required.
Training or certification in quality improvement (e.g., CQM, CQA, Lean Six Sigma, ISO).
Knowledge base of clinical standards of care, medical policy, coding, NCQA, CMS and other relevant state regulatory agency requirements.
Skills and Attributes:
Excellent analytical skills with the ability to assess complex business processes and data sets.
Strong program management skills with demonstrated ability to focus activities aligned with strategic priorities and to develop tactical plans, drive performance and achieve targets.
Demonstrated knowledge of healthcare insurance industry products (e.g. Medicare Advantage, Commercial, ASO, ACA).
Demonstrated knowledge of applicable locations of care (e.g., rehab, SNF, home care, and home and community bases services, etc.).
Excellent communication and presentation, time management, organizational, and prioritization skills.
Proven leadership skills with ability to motivate teams and facilitate large-scale change.
Detail oriented and organized with sound judgment, integrity, and ethical decision-making skills.
What You Will Do at Cambia:
Develop and oversee an effective clinical quality management/assurance program, including quality management strategies, policies, monitoring and reporting.
Analyze performance compared to internal and external benchmarks to identify opportunities for improvement.
Monitor all internal and delegated operations and related metrics for conformance with internal, external, contract performance, and quality standards.
Collaborate with stakeholders to identify and mitigate risks, error-proof systems, and uphold compliance standards.
Develop an effective quality assurance function including audits of systems, work processes, clinical determination and member engagement to identify opportunities to improve compliance and/or narrow unwarranted variation.
Plan and execute risk-based testing of key controls and processes to evaluate operating effectiveness against NCQA, CMS, state and contract requirements, as well as key business processes.
Oversee internal and vendor audit functions to assure a modernized audit function that produces thorough and objective audits.
Partner with shared services to implement improvements through workflow processes, training, and/or technical improvements to improve overall performance.
Collaborate with external auditors, regulatory agencies, and other stakeholders as needed to facilitate external audits and regulatory inspections.
Extract, aggregate, and analyze data to identify trends and opportunities for improvement.
Present findings and recommendations to management, committees, and external stakeholders.
Oversee process to track, monitor, and report on Corrective Action Plans.
Develop, update, and/or review policies and procedures related to quality management functions.
Champion a culture of ethics, integrity, and compliance throughout the organization by providing guidance, training, and support on internal control matters.
As a member of our strong leadership community, you will provide direction to your team, engage them towards common goals and create a positive experience that helps people flourish.
#LI-Remote
The expected hiring range for a Manager Clinical Quality Management & Compliance is $109,700 - $148,400 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $103,000 - $168,000.
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
Work alongside diverse teams building cutting-edge solutions to transform health care.
Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
Grow your career with a company committed to helping you succeed.
Give back to your community by participating in Cambia-supported outreach programs.
Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
