Quality Manager - RN (Remote, preferred within Illinois)

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Quality Manager – RN (Remote, preferred within Illinois) to join our growing team.

Job Summary:

Acentra Health is seeking a Quality Manager to join our team. As the Quality Manager, you will be responsible for developing, implementing, and monitoring our organization’s quality and performance improvement activities and clinical outcomes.  You will play a key role in supporting both medical and behavioral health departments in delivering high-quality care.

** This role preferred as Remote within the State of Illinois. **

** This role is contingent upon being awarded a contract. Start dates and final offers are contingent upon the contract award and final contract start dates. **

Job Responsibilities:

• Lead and facilitate all Quality and Performance Improvement (QPI) activities across the organization.
• Provide coaching and support to managers and staff regarding QPI.
• Ensure the implementation of key performance indicators and maintain systems for tracking, reporting, and improving performance.
• Assist in developing benchmarks for quality measures and outcomes.
• Facilitate access to relevant policies, procedures, and resources for staff.
• Promote awareness of customer requirements throughout the organization.
• Participate in existing Continuous Quality Improvement (CQI) activities, quality/outcome studies, and program development.
• Lead local quality improvement committee and participate in a clinical practice oversight committee.
• Support quality of care reviews and assist in resolving member grievances or complaints.
• Monitor and ensure staff have appropriate credentials and training.
• Conduct audits of utilization and case management cases.
• Monitor and report on quality indicators to identify opportunities for improvement.
• Develop and maintain Quality Improvement Processes (QIPs) in alignment with regulatory requirements.
• Evaluate program effectiveness and document quality metrics.
• Review member satisfaction surveys and compare them to performance indicators.
• Report critical incidents to corporate compliance and assist with action plans.
• Execute CQI plans to meet business requirements.
• Participate in preparing quarterly and annual quality reports for clients.
• Identify patterns and trends in clinical case and utilization management performance.
• Maintain the Department's Quality Management Plan and Program Description.
• Coordinate with Subject Matter Experts (SMEs) in developing clinical solutions.
• Support commercial implementations and Request for Proposal (RFP)/proposal processes for clients.

Requirements

Required Qualifications/Experience:

• Active, unrestricted Registered Nurse (RN) license in the State of Illinois.
• Bachelor's degree in nursing.
• Quality management experience in a health-related field.
• Solutioning and problem-solving experience in utilization and case management programs.
• 2+ years of case management experience.
• Knowledge of performance improvement strategies, principles, methodologies, techniques, and data analysis.
• Ability to provide leadership, maintain confidentiality, and meet deadlines.
• In-depth knowledge of Continuous Quality Improvement (CQI) tools, methods, and techniques (e.g., Six Sigma).
• Excellent grasp and understanding of Statistical Process Control (SPC).
• Strong analytical skills and ability to evaluate data objectively.
• Excellent communication, organizational, presentation, and interpersonal skills.
• Proficient in MS Office applications and Internet/web navigation.

Preferred Qualifications/Experience:

• Master’s degree in nursing.
• 1+ years of utilization management experience.
• Formal training or certification in quality (e.g., Certified Professional in Healthcare Quality [CPHQ], International Organization for Standardization [ISO], Six Sigma).
• Knowledge of Utilization Review Accreditation Commission (URAC), National Committee for Quality Assurance (NCQA), and/or ISO background.
• Experience with commercial health plans and/or clinical programs.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health 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, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.  

Compensation

The pay range for this position is $90,000-110,000

“Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”