Sr Manager, Quality Improvement (NCQA) (Sr. Manager II)

Sr Manager, Quality Improvement (NCQA) (Sr. Manager II)

CalOptima

CalOptima Health is seeking a highly motivated an experienced Sr Manager, Quality Improvement (NCQA) (Sr. Manager II) to join our team. The Sr Manager II (Quality Improvement) will oversee the day-to-day operations of the National Committee for Quality Assurance (NCQA) Accreditation team and lead CalOptima Health's NCQA Health Plan and Health Equity Accreditation efforts to ensure CalOptima Health achieves its renewal accreditation. The incumbent will work collaboratively with the Director and Executive Director of Quality Improvement and with internal business units to develop, maintain and evaluate the Quality Improvement Health Equity Transformation Program (QIHETP) and Work Plan. The incumbent will promote, integrate and drive quality improvement and health equity initiatives and activities throughout CalOptima Health to comply with NCQA Health Plan and Health Equity Accreditation processes and standards as well as regulatory, contractual and board requirements. Specifically, the incumbent will work to enhance and strengthen CalOptima Health's quality improvement and health equity infrastructure, including program, policy, contract compliance and statutory and regulatory obligations with NCQA, the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS).

Position Information:

• Department: Quality Improvement
• Salary Grade: 317 - $132,969 - $212,751 ($63.93 - $102.2841)
• Work Arrangement: Partial Telework
  
  **This position is eligible for telework in California.**

Duties & Responsibilities:

• 50% - Leadership Functions
  • Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
  • Hires, manages, trains, reviews and sets goals for the team and staff.
  • Leads CalOptima Health through the NCQA Health Plan and Health Equity Accreditation process and renewals and provides leadership to all business areas to ensure standards are known and met.
  • Leads the team to facilitate NCQA, DHCS and CMS regulatory audits and audit readiness activities for the Quality Improvement (QI) department.
  • Leads and facilitates the NCQA Steering Committee meeting.
  • Participates in and presents at the Quality Improvement and Health Equity Committee (QIHEC) and subcommittee meetings such as Utilization Management Committee (UMC), Member Experience Committee (MEMx), etc.
  • Promotes a culture of accountability, excellence and continuous improvement with provider partners through exemplary leadership practices.
    
    
• 45% - Program Oversight
  • Drives the development and maintenance of policies and procedures or desktop procedures that support effective collaboration, compliance and excellence for NCQA Health Plan and Health Equity Accreditation.
  • Develops and implements effective and standardized communication strategies to facilitate seamless information flow among internal and external business leads.
  • Drives the development, maintenance and evaluation of the QIHETP and Work Plan and ensures these documents comply with accreditation, contractual and regulatory requirements.
  • Engages and collaborates with all internal business leads to ensure QIHETP Work Plan elements are reported to and monitored by the QIHEC and subcommittees.
  • Collaborates with and educates all internal and health network business leads as new protocols or requirements emerge related to NCQA, DHCS and CMS regulatory requirements.
  • Engages and collaborates with all external NCQA and regulatory related vendors/organizations, including but not limited to NCQA and NCQA consultants, to ensure CalOptima Health complies with accreditation and regulatory requirements prior to submission and accreditation, or audit documents are submitted accurately and timely.
    
    
• 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

• Bachelor's degree in public health, health care administration, health care or related field PLUS 5 years professional NCQA, DHCS, CMS or other quality and regulatory experience in a managed health care organization required, preferably in a capitation model; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  
• Experience with NCQA, DHCS, CMS or other quality and regulatory standards required.

Preferred Qualifications:

• Master's degree in public health, health care administration, health care or related field.
  
• 5 years of experience in managed care, with a Medi-Cal managed health plan.
  
• 2 years of management or supervisory experience, preferably in health care.
  
• 2 years of project management experience, preferably in health care.

Required Licensure / Certifications:

• N/A

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2025 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.

IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is March 12, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.

Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.


To apply, please visit: https://jobs.caloptima.org/jobs/sr-manager-quality-improvement-ncqa-sr-manager-ii-505-city-parkway-west-california-united-states-76bbcffc-37b2-4472-bceb-f9a964278e8d







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