UM Quality Manager-Medicaid (Remote U.S.) - United States - Remote

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 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 UM Quality Manager-Medicaid (Remote U.S.) to join our growing team.

Job Summary:

• Under general supervision of the Program Director and in collaboration with the administrative team and Medical Director, the Quality Manager oversees the department responsible for internal and external Quality Review processes in accordance with the goals of the Colorado HCPF Utilization Management Contract.
• The Quality Manager also assists with the development of requirements for system configuration and reports.

Job Responsibilities:

• Ensure that the program meets or exceeds all contract Performance Standards.
• In collaboration with the Program Director, UM Manager, and clinical supervisors, responsible for the quality monitoring activities, including identifying areas of improvement and plan implementation of improvement areas.
• Oversee contract-specific Quality Program, providing guidance to the management team and client regarding quality-related issues.
• Focus on risk management, operations and infrastructure, performance monitoring and improvement, and consumer protection and empowerment in the day-to-day management of quality assurance activities for the contract.
• Manage program staff IRR and clinical documentation audit processes.
• Work …