Quality Program Manager

1895

Remote?: 1

Highlights (Bonus, shift, relocation, info for job):

This role would be primarily remote with occasional travel to AbsoluteCare offices

Job Summary

The Quality Program Manager is responsible to lead the development and execution of quality improvement initiatives within our value-based care model. The Quality Program Manager will play a pivotal role in driving improved clinical outcomes, closing care gaps, and enhancing documentation excellence. This individual will collaborate with interdisciplinary teams to implement innovative strategies that ensure compliance with regulatory standards, optimize risk adjustment, and advance member-centric care.

 

Duties and Responsibilities

Primary Responsibilities

• Program Development & Execution: Design and implement quality improvement programs aligned with AbsoluteCare’s mission to deliver whole-person, value-based care for complex and high-risk populations.
• Data Analysis & Reporting: Collaborate with our Medical Economics team to monitor, analyze, and report quality metrics (e.g., HEDIS, CMS Star Ratings, risk adjustment measures) to identify trends and provide actionable insights to leadership and care teams.
• Care Gap Closure: Collaborate with clinical and operational teams to develop and execute strategies for closing care gaps, with a focus on preventive services and chronic condition management.
• Clinical Documentation Excellence: Partner with the Lead to design integrated initiatives for providers and documentation improvement specialists to ensure accurate and thorough medical record documentation, supporting risk adjustment and quality outcomes.
• Stakeholder Collaboration: Serve as the enterprise liaison between local market teams, market medical directors, and corporate leadership to ensure quality initiatives are effectively implemented and tailored to market needs.
• Regulatory Compliance: Oversee adherence to all quality-related regulatory requirements, including NCQA, CMS, and state-specific guidelines.

 

Secondary Responsibilities

• Education & Training: Create and deliver training programs on quality improvement methodologies, compliance standards, and effective data utilization for clinical and operational staff.
• Process Improvement: Identify opportunities for operational improvements across markets, utilizing frameworks such as PDSA, Lean, or Six Sigma.
• Member Experience Enhancement: Contribute to initiatives aimed at improving member satisfaction and engagement through quality-driven care models.
• Accreditation Support: Lead preparation for accreditation and certification processes, ensuring the organization is audit ready.
• Cross-Departmental Support: Work with other departments, such as behavioral health and pharmacy, to ensure integrated approaches to quality improvement across AbsoluteCare’s multidisciplinary teams.

 

Minimum Qualifications

Required Qualifications:

• Bachelor’s degree in healthcare administration, nursing, public health, or a related field. Master’s degree preferred.
• Minimum 5 years of experience in healthcare quality improvement or program management, preferably in value-based care or population health settings.
• Proven track record of success with quality programs focused on complex and high-risk populations.
• Deep understanding of quality metrics (HEDIS, CMS Stars), risk adjustment methodologies, and clinical documentation improvement (CDI).
• Strong analytical and problem-solving skills, with proficiency in EHR platforms like eClinicalWorks.
• Excellent interpersonal and communication skills to engage and influence diverse stakeholders.
• Ability to work in a fast-paced, collaborative environment with a focus on mission-driven outcomes.

Preferred Qualifications:

• Certified Professional in Healthcare Quality (CPHQ)

Working conditions

• This job operates in a remote location from your home location. This role requires a dedicated, quiet workspace with the ability to adhere to HIPPA and other privacy policies.  A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.
• Occasional travel to AbsoluteCare offices

 

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment.
• Job may be physically demanding at times.
• Repetitious Movements.

• Ability to occasionally move objects up to 20 lbs.

 

Direct reports

None

Why Work at AbsoluteCare?

At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer. 

We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.

We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works. 

Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT².

AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

EEO Employer Verbiage: AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.