Clinical Quality Program Manager

This job is responsible for ensuring compliance with WellSky's Utilization Management and Quality Improvement Program by serving as a clinical expert on state and federal regulations. The scope of this job includes analyzing and presenting data to establish best practices across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities. Key Responsibilities: • Facilitate activities related to performance measurement and outcomes, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices. • Generate and validate reports to monitor performance across health plan contracts, ensuring accuracy and alignment with requirements. • Conduct regular audits of UM decisions, case documentation, turnaround times, and adherence to other CMS and NCQA requirements. • Understand how the UM Program is driven by the NCQA UM standards to ensure UM Program meets all NCQA requirements for accreditation. • Prepare and lead committee meetings on a monthly and quarterly basis, driven by NCQA requirements. • Prepare detailed quality reports, identify and analyze trends, and present findings to leadership with actionable recommendations. • Support implementing corrective action plans when scoring variances occur. • Support quality improvement project initiatives. • Prepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings. • Perform other job duties as assigned. Required Qualifications: • At least 4-6 years relevant work experience • Experience leading quality improvement projects and committee work. • Bachelor's Degree or equivalent work experience Preferred Qualifications: • Active, unrestricted license: RN, PT, OT or SLP, with a bachelor's degree in a related field or a combination of education and experience that includes pertinent clinical experience and advanced working knowledge of CMS standards and guidelines. • At minimum, 1-2 years of working knowledge of NCQA UM accreditation standards. • Must be able to prioritize, plan and handle multiple tasks and demands simultaneously, with competing deadlines. • Excellent in manipulating and sorting data for analytics and reporting. • Prior experience owning client compliance SLAs and ensuring success in meeting SLA requirements. Job Expectations: • Willing to work additional or irregular hours as needed. • Must work in accordance with applicable security policies and procedures to safeguard company and client information. • Must be able to sit and view a computer screen for extended periods of time. • Travel approximately 10%. #LI-PG1 # Remote Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: • Excellent medical with Rx, dental, and vision benefits • Mental Health support through EAP • Generous paid time off, plus 13 paid holidays • 100% vested 401(K) retirement plans • Educational assistance up to $2500 per year