A Clinical Quality Manager ensures that the quality of the work in a clinical environment is consistent and meets government and industry standards as well as customer expectations. Verifies compliance with health and safety regulations. Coordinates all activities related to quality assurance and monitoring and revises existing processes in order to increase efficiency.
Director of Quality Improvement LSMA Management Inc San Bernardino, CA Job Details Full-time $130,000 - $145,000 a year 14 hours ago Qualifications Phone communication Writing skills CMS CMS regulatory compliance Supervising experience Health insurance knowledge Project management experience in healthcare Productivity software Cross-functional collaboration Clinical data analysis General management Cross-functional communication
Full Job Description Description:
JOB SUMMARY
The Director of Quality Improvement is responsible for the strategic leadership, development, implementation, and oversight of the organization's Quality Improvement (QI) Program within a healthcare Management Services Organization (MSO) environment. This role ensures compliance with applicable federal and California state regulations, including DMHC, CMS, and NCQA standards, as well as health plan contractual requirements. The Director works collaboratively with executive leadership, affiliated Independent Practice Associations (IPAs), medical groups, providers, and health plans to drive measurable improvements in clinical quality, patient safety, access to care, member satisfaction, and population health outcomes. The position requires strong analytical capabilities, regulatory expertise, and leadership skills.
Requirements:
MINIMUM & PREFERRED QUALIFICATIONS
Education/Training Minimum:
Bachelor's degree in Healthcare Administration, Nursing, Public Health, or related field.
Preferred:
Master's degree (MPH, MHA, MBA, or related clinical discipline)
Experience Minimum:
Five (5) years of experience in healthcare quality improvement, managed care, or healthcare compliance. Two (2) years of leadership of supervisory experience.
Preferred:
Experience within a California MSO, IPA, or health plan environment. Direct experience with
HEDIS, CMS
Star Ratings, and NCQA accreditation. Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. Certification(s)
Preferred:
Certified Professional in Healthcare Quality (CPHQ), current California Registered Nursing (RN) License. Skills, Knowledge & Abilities Strong knowledge of DMHC, CMS, NCQA, and managed care regulations Advanced analytical and data interpretation skills Excellent written, verbal, and presentation communication skills Ability to influence cross-functional teams and provider networks Strong organizational, leadership, and project management skills Proficiency in Microsoft Office and healthcare data/reporting systems
PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS
The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job, with or without reasonable accommodation. The role requires prolonged periods of sitting, frequent use of a computer, and extensive data analysis. The employee may occasionally be required to stand, walk, bend, and lift items weighing up to 20 pounds. This position includes frequent travel within California, which may comprise up to approximately 50% of the employee's time, for purposes such as site visits, audits, and meetings. The role also requires the ability to communicate effectively and clearly in person, by telephone, and in written formats, as well as the ability to manage multiple priorities and deadlines in a dynamic, fast-paced healthcare environment.
