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Youth Development Specialist- SPARK Academy
The Salvation Army Central Territory
St. Louis, MO
- $16 USD / hour
The Salvation Army Midland Division Ferguson Community Empowerment Center is looking for a Youth Development Specialist for the Spark Academy. This individual would be responsible for…
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Assistant Professor of Business-Strategic Management
Linfield University
McMinnville, OR
- $85,000 USD / year
Contribute to curriculum development, academic program assessment, and continuous improvement efforts.
Added 1 min ago
FC
Special Education Instructional Assistant, Specialized Program
Frederick County Public Schools
Frederick, MD
- $24.32 USD / hour
…special needs to implement the student's Individualized Education Program (IEP) for students that participate in Frederick County Public Schools (FCPS) Specialized Programs (Expressions,…
Added 1 min ago
Front Line Manager
CAR CarMax Auto Superstores, Inc.
DE
As a Front-Line Manager in Training, you will participate in a structured six-week development program designed to prepare you for success as a Front-Line Manager within CarMax’s Service…
Added 2 mins ago
General Manager
Wawa Inc. (210515330)
Lima, OH
…everything from daily operations and store profitability to team development and customer satisfaction. With your leadership, your team will work together to hit performance goals and grow…
Added 2 mins ago
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Bankruptcy Associate Attorney
GPAC
Los Angeles, CA
- $140,000 to $190,000 USD / year
Bankruptcy Associate Attorney – Los Angeles, CA
Added 2 mins ago
Paraeducator Early Education-Bilingual (Spanish) 11-2026
Escondido Union School District
Escondido, CA
…completion of six units of Early Childhood Education or Child Development coursework from an accredited educational institution and one of the following: 1) completion of at least two years…
Added 3 mins ago
Senior Investor Communications Specialist - Asia
UP MANAGEMENT LLC
Dallas, TX
5% - Asia market strategy and business development - Work closely with senior management on Asian market strategy. Work closely with investor relations colleagues and provide input on…
Added 3 mins ago
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Associate District Sales Manager | Lyric HCM
ADP
Ga Home Office, GA
- $62,700 to $124,700 USD / year
ADP is hiring an Associate District Sales Manager | Lyric HCM
Added 3 mins ago
Relationship Banker I - Madison Branch
Regions Bank
Madison, GA
…interested in beginning a career with opportunities for growth, development, and upward…
Added 3 mins ago
MI
LTL Warehouse Associate MS Mon-Fri 3:00pm-11:30pm
MSC Industrial Supply Co.
Mableton, GA
- $20 USD / hour
Our commitment to internal growth and the development of our associates is unwavering. We believe that investing in our team members professional journey not only benefits them individually…
Added 3 mins ago
MI
Shipping Clerk Mon-Fri 9:30am-6:00pm
MSC Industrial Supply Co.
Mableton, GA
- From $18.75 USD / hour
Our commitment to internal growth and the development of our associates is unwavering. We believe that investing in our team members professional journey not only benefits them individually…
Added 3 mins ago
MI
LTL Warehouse Associate VC Mon-Fri 3:00pm-11:30pm
MSC Industrial Supply Co.
Mableton, GA
- From $20 USD / hour
Our commitment to internal growth and the development of our associates is unwavering. We believe that investing in our team members professional journey not only benefits them individually…
Added 3 mins ago
MI
Warehouse Associate VC Mon-Fri 9:30am-6:00pm
MSC Industrial Supply Co.
Mableton, GA
- From $18.75 USD / hour
Our commitment to internal growth and the development of our associates is unwavering. We believe that investing in our team members professional journey not only benefits them individually…
Added 3 mins ago
MI
Warehouse Associate MS Mon-Fri 12:00pm-8:30pm
MSC Industrial Supply Co.
Mableton, GA
- $20 USD / hour
Our commitment to internal growth and the development of our associates is unwavering. We believe that investing in our team members professional journey not only benefits them individually…
Added 3 mins ago
Transfer Specialist
SCI Shared Resources, LLC
Sandy Springs, GA
Our Associate Resource Communities (ARCs) are associate-led, self-directed groups of Company colleagues who share similar interests and backgrounds. ARCs offer opportunities to connect with…
Added 3 mins ago
Relationship Banker II - Smyrna Main Branch
Regions Bank
Smyrna, GA
…interested in beginning a career with opportunities for growth, development, and upward…
Added 3 mins ago
Manager, Manufacturing Engineering
Bath & Body Works
New Albany, OH
We believe great associate experiences create great consumer experiences. When our associates feel supported, inspired and empowered, consumers feel it. Whether you're starting your career…
Added 3 mins ago
Manager, Store
Ross Stores, Inc.
Pooler, GA
Executes Customer service programs and Merchandise Presentation programs through Associate training and program supervision.
Added 4 mins ago
Designer III
Hargrove Engineers & Constructors
Carrollton, GA
Education: Bachelor or Master of Science degree in Electrical Engineering or Associate degree in Engineering Technology or Computer Aided Drafting and Design from an accredited university…
Added 4 mins ago
Assistant Nurse Manager, Med Surg with Telemetry Nights
AdventHealth
Rome, GA
…salary increases of up to 20%* through our Clinical Ladder Program based on experience, professional development, and achievement of advancement…
Added 4 mins ago
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LPN The Residence at Great Woods
LCB Senior Living
Norton, MA
- $40 to $43 USD / hour
The essential duties and responsibilities described below are representative of those an associate encounters while performing the basic functions of this position. While every effort has…
Added 4 mins ago
LS
Assistant Director of Nursing The Residence at Glastonbury
LCB Senior Living
Glastonbury, CT
- $46.5 to $49.5 USD / hour
Assist with the evaluation of resident needs and the development and revision of service plans as per state regulatory requirements.
Added 4 mins ago
Sales & Business Development Associate
Wolters Kluwer
Kennesaw, GA
As a Sales & Business Development Associate you will own prospecting and outreach across assigned territories and accounts. You'll generate pipeline through strategic outreach via multiple…
Added 4 mins ago
BP
Veterinary Assistant
Banfield Pet Hospital
Suwanee, GA
- $16.47 to $21.05 USD / hour
If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs.

AmeriHealth Caritas Health Plan

Director Quality Management

Philadelphia, PA, United States

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Job details

Education: Bachelor’s degree
Posting language: English
Posted: Nov 6, 2026

Original job description

Role Overview: The primary purpose of the job is to be responsible and accountable for the successful, ongoing development, refinement, implementation, measurement, ongoing quality improvement and effectiveness of Long Term Services & Support (LTSS).

Work Arrangement:

Remote - This posiiton is fully remote, and the Associate must be in Pennsylvania (PA)
Travel to state & leadership meeting as needed.
Reliable high‑speed internet required (minimum 50 Mbps download / 5 Mbps upload)
Associates residing in states where reimbursement is required by contract, law, or regulation may submit eligible expenses for reimbursement

Responsibilities:

Overseeing quality management for Long Term Services and Supports (LTSS) in PA
Accountable for ongoing maintenance of the Plan’s compliance with state regulations and National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC) and other appropriate standards for activities related to Quality, Care Management and Utilization Management.
This includes credentialing/re-credentialing activity, delegation oversight, quality of care investigations as well as the corresponding inter- and intra-departmental coordination, communication, and education.
Oversight and responsibility for the Plan’s, Line of Business or Product Line’s QAPIC Committee structure and support.
Works directly with Senior Executives to plan, organize and direct the identification, prioritization and implementation of strategic projects that improve financial, service and clinical outcomes for the Plan, LOB or Product Line.
In coordination with Plan stakeholders, develop, implement and lead strategy to improve HEDIS outcomes and maximize pay for performance payout and reduce withholds and/or liquidated damages
Provides functional support to the Network Management, Informatics, Information Solutions, Care Coordination, Utilization Management, and Public Affairs departments to integrate Quality Management initiatives and goals with organizational programs.

Education & Experience:

Bachelor’s degree required
An active unrestricted licensed Registered Nurse (RN) in PA or healthcare quality certification such as American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or Certified Professional in Healthcare Quality (CPHQ) in accordance with state specific requirements
1 to 3 years of experience in Medicaid.
5 to 10 years of experience in a clinical setting
5 or more years of experience in managed care and leadership.
Prior URAC or NCQA Accreditation experience

Skills & Abilities:

Strong leadership and people-management skills, with the ability to supervise, coach, develop, and provide performance feedback to quality management staff.
Extensive knowledge of healthcare quality assurance, quality improvement, outcomes management, and performance improvement principles and practices.
Ability to develop and present comprehensive quality reports, analyses, recommendations, and performance findings to leadership and cross-functional stakeholders.
Strong project and program management skills, with the ability to manage multiple quality initiatives, priorities, deadlines, and contractual deliverables.
Excellent verbal and written communication skills, with the ability to communicate effectively with internal teams, leadership, providers, and external stakeholders.
Strong presentation and facilitation skills, including the ability to communicate complex quality and clinical information clearly to varied audiences.
Demonstrated problem-solving, critical-thinking, and independent decision-making skills.
Ability to identify opportunities for process improvement and lead the development and implementation of improved clinical and administrative processes.
Strong interpersonal and conflict-resolution skills, with the ability to effectively manage difficult or sensitive situations.
Ability to collaborate across departments and build strong working relationships to support organization-wide quality improvement initiatives.
Strong organizational and time-management skills with excellent attention to detail.
Proficiency with Microsoft Office applications and the ability to effectively use technology for reporting, data analysis, documentation, and communication.

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