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WellSkyClinical Quality Program Manager
WellSky is seeking a Clinical Quality Program Manager to act as a clinical subject matter expert regarding state and federal regulations. In this remote, full-time position,…
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About This Role
WellSky is seeking a Clinical Quality Program Manager to act as a clinical subject matter expert regarding state and federal regulations. In this remote, full-time position, the professional will ensure adherence to the Utilization Management and Quality Improvement Program across various post-acute care settings such as SNFs, LTACHs, IRFs, and Home Health facilities. The role involves driving performance measurement, supporting compliance with CMS and NCQA standards, analyzing data trends, and…
Job Description
WellSky is seeking a Clinical Quality Program Manager to act as a clinical subject matter expert regarding state and federal regulations. In this remote, full-time position, the professional will ensure adherence to the Utilization Management and Quality Improvement Program across various post-acute care settings such as SNFs, LTACHs, IRFs, and Home Health facilities.
The role involves driving performance measurement, supporting compliance with CMS and NCQA standards, analyzing data trends, and facilitating committee meetings. It suits a clinical professional experienced in quality improvement, healthcare analytics, and regulatory compliance who wants to contribute to shaping the future of healthcare.
Responsibilities
- Facilitate performance measurement and outcome activities to meet CMS and NCQA standards
- Generate and validate monitoring reports across health plan contracts
- Audit utilization management decisions, documentation, turnaround times, and regulatory adherence
- Prepare and lead monthly and quarterly committee meetings based on NCQA requirements
- Analyze data trends and present findings with actionable recommendations to leadership
- Support corrective action plans and quality improvement initiatives
- Prepare for contractual, regulatory, and accreditation audits while contributing to remediation and documentation
- Safeguard company and client data in line with security policies
Requirements
- At least four to six years of relevant work experience
- Experience leading quality improvement projects and committee work
- Bachelor's Degree or equivalent work experience
- Willingness to work additional or irregular hours when necessary
- Ability to travel approximately 10 percent of the time
- Legal authorization to work in the United States
Qualifications
- Active, unrestricted license as an RN, PT, OT, or SLP
- Bachelor's degree in a related field or a combination of education and experience featuring clinical background and knowledge of CMS standards
- Minimum of one to two years of working knowledge of NCQA utilization management accreditation standards
- Strong ability to prioritize and manage multiple demands simultaneously
- Advanced proficiency in data sorting and manipulation for reporting and analytics
- Prior ownership of client compliance service-level agreements
Core Skills
Benefits
- Medical coverage with prescription benefits
- Dental and vision benefits
- Mental health support through an Employee Assistance Program
- Generous paid time off and 13 paid holidays
- 100 percent vested 401(k) retirement plans
- Educational assistance of up to $2500 per year
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, the source posting explicitly states that the role is remote.
What is the salary for this position?
The salary is not specified in the job posting.
What level of experience is required?
The role requires at least four to six years of relevant work experience, along with a bachelor's degree or equivalent work experience and a history of leading quality improvement projects.
What travel is expected for this role?
The position requires approximately 10 percent travel.
Sample Interview Questions
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