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Front Office Coordinator
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Mount Clemens, MI
…proficiency in standard office equipment and Microsoft Office applications, along with excellent communication and organizational skills to ensure a welcoming and efficient environment for…
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Bellingham, WA
…information and/or documentation, make recommendations, and process applications as appropriate. Provide timely, clear and concise communication throughout the application process to…
Added 1 min ago
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Staff Engineer
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Stockroom Operations Lead, HOKA
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Proficient in Microsoft Office suite of tools and applications.
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AI and DSP Applications Software Engineer
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Automation Tester
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…the functionality, reliability, and performance of enterprise applications. The Automation Tester will focus on building robust automated testing solutions for functional, API, and user…
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Research Analyst I, Bioanalysis LBA
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MI
- $23.5 USD / hour
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Compliance & Enrollment Operations Manager
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Poughkeepsie, NY
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Help ensure applications, documentation, eligibility requirements, and renewals are handled accurately and on time.
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Food Service - Restaurant Supervisor
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Human Resources Assistant
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Part time NOC Caregiver
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Lead Software Engineer - Enterprise AI Services & Agents
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Area Manager - Systems (Grocery)
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Software Developer
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United States
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Sales Manager (Part Time)
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Applications will be accepted until at least 7 days after the posting date.
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Applications will be accepted until at least 3 days after the posting date.
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Applications will be accepted until at least 3 days after the posting date.
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Applications will be accepted until at least 3 days after the posting date.
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Sales Manager (Part Time)
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- $20.75 to $24.75 USD / hour
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Seasonal Associate
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Applications will be accepted until at least 3 days after the posting date.
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Holiday Helper
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- $17.5 to $19.75 USD / hour
Applications will be accepted until at least 3 days after the posting date.
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Record Production Assistant
Harris County District Attorney's Office
Houston, TX
- $22.44 to $27.18 USD / hour
Due to the high volume of applications we receive, we are unable to provide individual status updates. If selected for an interview, you will be contacted directly by a recruiter. We…
Added 2 mins ago
Senior Full Stack Engineer
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Architect and build scalable web applications and services that serve millions of Bilt members
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Project Coordinator
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Orlando, FL
- $75,000 to $90,000 USD / year
Strong proficiency in Microsoft Office applications, particularly Excel, Word, PowerPoint, and Outlook.

Amerihealth Caritas

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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More about this job

Skills

Quality assurance procedures
Leadership
Regulatory compliance
Quality assurance
Communication skills
Prioritization
Network administration
RN
Team leadership
Provide performance feedback
Program management
Problem solving
Critical thinking
Decision making
Process improvement
Conflict resolution
Time management
Attention to detail
Microsoft Office
Reporting
Data analysis
Documentation

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