Senior Manager, Quality Improvement

Active, unrestricted RN license (required) Bachelor’s degree in Nursing or a related field (Master’s preferred) Minimum 3 years of experience in Medicare Advantage or similar managed care setting Deep knowledge of CMS MMCM Chapter 4 (Benefits & Beneficiary Protections) and Chapter 5 (Quality Improvement Program) requirements Experience in regulatory compliance, QI program oversight, and audit readiness At least 3 years of leadership experience, including direct team management Strong skills in data analysis, performance monitoring, and process improvement Proficiency with Microsoft Office and Google Suite Excellent written and verbal communication skills

Oversee Regulatory QI Program Elements Lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan Ensure timely completion of annual QI Program Evaluation Manage QI Committee activities Ensure CMS, NCQA, and state QI requirements are met and documented Maintain audit readiness for CMS Program Audits and state/federal reviews Partner with Legal and Compliance teams to interpret new regulations Oversee Quality of Care (QOC) investigations Collaborate with Medical Directors and clinical teams on QOC determinations Support Star Ratings strategy Present QI outcomes, trends, and opportunities to senior leadership Implement cross-functional improvement initiatives Supervise a team of QI professionals Lead cross-departmental working groups Foster a culture of quality, compliance, and continuous improvement