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Clinical Quality Manager
Fort Washington, PA
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Clinical Quality Manager - Remote in Pennsylvania
Requisition number: 2377858
Job category: Medical & Clinical Operations
Primary location: Fort Washington, Pennsylvania
Additional locations: Philadelphia, Pennsylvania
Date posted: 07/21/2026
Overtime status: Exempt
Travel:
Yes, 10 % of the Time
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Email At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Quality Management Manager will monitor and support the health plan quality improvement initiatives with particular emphasis on HEDIS, NCQA, and State Performance measures. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. If you are located in Pennsylvania, you will have the flexibility to work remotely• as you take on some tough challenges. This position will travel up to 10% in the PA market.
Primary Responsibilities:
Oversee the implementation of plan's quality improvement program (QAPI)
Work to coordinate the work with the clinical, operations, and network teams to improve HEDIS and NCQA performance and to close gaps in care
Manage Quality work plan programs and activities
Collaborate across local and national business segments to achieve goals and targets
Develop and maintain positive relationships with external state organizations within the scope of Quality Management
Continuously monitor HEDIS, NCQA, and state performance measure results and adjust programs to ensure targeted goals
Support Performance Improvement Projects, accreditation, and regulatory audits as needed
Develop and mentor quality department staff
Oversee quality quarterly review meetings with state partners
Serve as panelist for grievance and appeal hearings You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
RN License in the state of Pennsylvania AND/OR Master's degree in a Healthcare Field (e.g. Public Health, Health Administration, Health Education, etc.) Experience with HEDIS and NCQA - quality improvement project experience
Experience managing staff or staff mgmt. for projects
Experience writing reports and managed care industry
Experience with outside audit organizations such as External Quality Review Organizations (EQROs) Reside in the state of Pennsylvania and ability to travel up to 10% in the PA market