Jobs in the United States

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Added 1 min ago
Quality Engineering Manager - Data Centers
E Tech Group
Frederick, MD · Plano, TX
Develop and maintain the project Quality Management System and site-specific Quality Management Plan in alignment with ISO 9001 principles, CSIA Best Practices, applicable PMI practices,…
Added 1 min ago
HI
Hospital Business Unit Sterile Injectables Senior Health and Science Sales Specialist - Mobile, AL
Hospira, Inc.
Remote, United States
- $108,600 to $250,700 USD / year
…strong sales, promotional and strategic business development and management skills and in-depth customer engagement expertise in both virtual and in-person settings, utilize a systematic…
Added 3 mins ago
Assistant Director of Service and Community Living
University of South Carolina
SC
…Salkehatchie, Union, Lancaster and Sumter enable students to earn associate or bachelor’s degrees through a combination of in-person, online or blended learning. All of our system…
Added 4 mins ago
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Pre-Analytical Supervisor
Helix
United States
- $47 to $60 USD / hour
Project management experience or PMP certification.
Added 4 mins ago
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US Oncology Associate Medical Director, Lung
AstraZeneca
Gaithersburg, MD · Gaithersburg
- $150,202 to $225,303 USD / year
Added 5 mins ago
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Sr. Store Planner
adecco
Marlborough, MA
- $40.21 USD / hour
Associate or Bachelor's degree in Architecture, Interior Design, Construction Management, Architectural Engineering Technology, or a related field.
Added 5 mins ago
T
Project Coordinator
TechnoGuard
Sterling, VA
- $65,000 to $80,000 USD / year
Reports To: Project Manager / Director of Project Management
Added 5 mins ago
BP
Area Chief of Staff
Banfield Pet Hospital
Wilmington, DE
- $130,000 to $185,000 USD / year
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.
Added 6 mins ago
Associate DMS Applications Engineer
Open Systems International, Inc.
Medina, MN
Aspen Tech’s Advanced Distribution Management System (ADMS) is a high growth area in our business that unlocks an electric distribution utility’s ability to monitor, manage, control, and…
Added 7 mins ago
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Full Time - Loader/Cart Associate - Opening
Lowes
Michigan City, IN
- Full-time
Assists customers with locating, selecting, carrying, and loading merchandise while responding promptly to customers and associate questions
Added 8 mins ago
Administrative Project Coordinator
HDR
Ann Arbor, MI
Work with project managers to efficiently set up their projects including creating of project folders, developing Project Management Plans, Quality Management Plans, loading project review…
Added 8 mins ago
Union Party Chief (Survey Technician)
Stantec
Santa Barbara, CA
…serve, we provide planning, engineering, and infrastructure management services that fit the needs of our clients and improve the overall transportation experience. Join our team and help…
Added 8 mins ago
Associate Document Imaging Administrator
Open Text Inc.
San Antonio, TX
OpenText is a global leader in information management, where innovation, creativity, and collaboration are the key components of our corporate culture. As a member of our team, you will…
Added 9 mins ago
Dispatcher
Terracon
Austin, TX
Associate degree in project, construction or business management
Added 9 mins ago
Sr. Manager - Projects and Engineering 4D
Genpact LLC
United States
Project Management Expertise Proven experience in Agile/Scrum methodologies, PMP certification preferred. Skilled in tools such as Azure DevOps, Jira, and MS Project.
Added 9 mins ago
CRA I - Sponsor Dedicated | Oncology / Neurology (Home-Based - Cleveland / Columbus, OH)
Syneos Health, LLC
Remote, United States
Performs site qualification, site initiation, interim monitoring, site management activities and close-out visits (performed on-site or remotely) ensuring regulatory, ICH-GCP and/or Good…
Added 9 mins ago
Executive Assistant I
OhioHealth Corporation
United States
Added 9 mins ago
Epic System Analyst - Optime/Anesthesia
OhioHealth Corporation
WORK AT HOME, OH
…knowledge of healthcare workflows, system integration, and project delivery practices while partnering with operational leaders and end users to translate business requirements into…
Added 9 mins ago
IT Tech Lead -Revenue Cycle Applications
OhioHealth Corporation
WORK AT HOME, OH
Project work may include application development, API tooling, and system design to enable external applications with database secure access to RDBMS or No SQL, and related tasks.
Added 9 mins ago
INS/Principal - P&C Insurance
Infosys
United States
Functional Areas – Product development, Product Consolidation, P&C Claims Management and Distribution Management
Added 11 mins ago
Tenant Service Liaison
PROMESA R.H.C.F.
Bronx, NY
…by the Urban Renaissance Collaborative Year 15 redevelopment project. The project includes property improvements which may require tenants to be temporarily relocated while work is…
Added 11 mins ago
AF
Test Automation Engineer - 6596991
Accenture Flex LLC Company
United States
- $33 to $43 USD / hour
Accenture Flex offers you the flexibility of local fixed-duration project-based work powered by Accenture, a leading global professional services company. Accenture is consistently…
Added 11 mins ago
TI
Equipment Servicing Technician
TSRC INC
Ashland, VA
- $20 to $25 USD / hour
Delivers excellent customer service at all times, providing in-person and phone updates to clients regarding technician presence and project updates as appropriate
Added 11 mins ago
4I
Associate Planner
4LEAF, Inc
Del Mar, CA
- $81,000 to $99,000 USD / year
…of planning, building and safety, engineering, construction management, and fire consulting services, 4LEAF has an enviable track record of completing complex projects and staffing…
Added 12 mins ago
Billing Specialist
U.S. Legal Support
Houston, TX
Experience working with ERP systems and project management tools.

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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