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Esthetician / Laser Associate
REMOVERY LLC
Houston, TX, TX
- $26 to $30 USD / hour
As an Esthetician/Laser Associate you are the to the go-to laser expert in this studio. Your responsibilities include administering safe laser treatments, educating clients on the removal…
Added 1 min ago
BP
Retail Store Associate
Batteries Plus - GEN Aspire, LLC
Virginia Beach, VA
- $14 to $15 USD / hour
Added 1 min ago
GH
RN - Labor and Delivery Registered Nurse
Genesis Health System
United States
- $32.74 to $49.11 USD / hour
Visit MercyOne Careers to learn more about the benefits, culture, and career development opportunities available to you at MercyOne Health System circle of care.
Added 1 min ago
Unit Secretary - Per Diem - ER
Trinity Health Of New England Corporation, Inc.
Hartford, CT
Education: Minimum of a high school diploma or GED. Business school or Associate Degree in Business preferred.
Added 1 min ago
Senior Treasury Analyst - Cash Operations (Hybrid)
Trinity Health Corporation
Livonia, MI
The centralized Cash Management Program processes over $7 billion annually. Responsible for the daily operation and monthly reporting of the centralized Cash Management Program, which…
Added 1 min ago
Executive Chef
Trinity Health Corporation
Muskegon, MI
…General Manager is kept abreast of issues or problems impacting program efficiencies and effectiveness. Attracts, develops and trains talent to ensure program quality, sustainability,…
Added 1 min ago
Practice Director - Surgery
The US Oncology Network
Austin, TX
…participate in our Long-Term Incentive Plan (LTIP): an incentive program designed to attract, retain, and reward top…
Added 2 mins ago
Associate Director (Engineering), Biologics External Manufacturing Technical Operations
Merck
West Point, PA · Manchester, NH
The Associate Director, Engineering within Biologics External Manufacturing Technology is accountable for achieving excellence in Compliance, Supply, Continuous Improvement & Cost Reduction…
Added 2 mins ago
Project Control Associate
Abt Global
Rockville, MD · Atlanta, GA · Cambridge, MA
As the Project Control Associate, you will perform day-to-day Costpoint project setup and ongoing project maintenance under established standards and manager oversight. Supports accurate,…
Added 3 mins ago
NU
Instructional Assistant III Mod/Severe - H. Allen Hight Elementary (6 hr day) *REPOSTED
Natomas Unified School District
Sacramento, CA
- $23.36 to $29.31 USD / hour
…education instructional programs. Assist teachers and staff in development and implementation of programs. Incumbents must be able to work with special needs populations and provide support…
Added 3 mins ago
SC
School Nurse
Santa Clara County Office Of Education
San Jose, CA
- $91,751.85 to $171,634.2 USD / year
…team member with support personnel to provide an educational program which promotes the physical, emotional and mental health of students served by the Santa Clara County Office of…
Added 3 mins ago
Associate Marketing Manager, Fever Tree
Molson Coors
Chicago, IL
In the role of Associate Marketing Manager on Fever-Tree, you’ll help us build a category-leading premium mixer brand and a strategic growth priority for Molson Coors. You’ll operate as a…
Added 4 mins ago
Accounting Clerk $24-$25/hour
Crescent Hotels
Oak Brook, IL
…our health & wellness programs, best in class learning and development or our travel discounts that ‘feed your inner explorer’, we work hard to create and deliver on what YOU need. We are…
Added 4 mins ago
Associate Director of HR
New York Shakespeare Festival
New York, NY
The Associate Director of Human Resources provides senior-level operational leadership for the HR department of one of the most visible and historied not-for-profit theaters in the country.…
Added 4 mins ago
NC
Instructional Support Assistant/Student Success Coach 2026-2027 (Temporary)
North Carolina Jobs
NC
- $15 to $25 USD / hour
…students needing extra support to succeed in an educational or program…
Added 4 mins ago
Relationship Banker II - Corydon Plaza
Regions
Corydon, IN
…interested in beginning a career with opportunities for growth, development, and upward…
Added 4 mins ago
Relationship Banker I - Mulberry
Regions
Waterloo, IA
…interested in beginning a career with opportunities for growth, development, and upward…
Added 4 mins ago
Relationship Banker II - Mulberry
Regions
Waterloo, IA
…interested in beginning a career with opportunities for growth, development, and upward…
Added 5 mins ago
Category Manager I-II
Oncor
Ft Worth, TX
…guidance from senior team members. These responsibilities include development of Request for Information, Request for Proposals, pre-bid conferences, response evaluation and scoring, and…
Added 5 mins ago
Retail Sales Associate (Brand Ambassador)-The Promenade Shops at Sauco
Bath & Body Works
Center Valley, PA
Career Development | Fun Stores | Free Product | 40% Discount
Added 5 mins ago
Retail Brand Experience Supervisor-WASHINGTON SQUARE MALL
Bath & Body Works
Washington, NC · Washington, WA
401k with company match and Associate Stock Purchase program with discount.
Added 5 mins ago
Retail Brand Experience Supervisor-DEERFIELD PLACE
Bath & Body Works
Milton, GA
401k with company match and Associate Stock Purchase program with discount.
Added 5 mins ago
SV
(South Mountain) Paraprofessional (November Start)
Sun Valley Academy
Phoenix, AZ
- From $18 USD / hour
Assist with recordkeeping for the instructional program and student records.
Added 5 mins ago
SV
(Glendale) Preschool Assistant Teacher (November Start)
Sun Valley Academy
Glendale, AZ
- $18 USD / hour
Actively working toward an Early Childhood Education (ECE) certification, Child Development Associate (CDA) credential, or degree in a related field.
Added 7 mins ago
Executive Chef
Trinity Health
Muskegon, MI
…General Manager is kept abreast of issues or problems impacting program efficiencies and effectiveness. Attracts, develops and trains talent to ensure program quality, sustainability,…

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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