Clinical Quality Manager (Remote)

Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: Job Summary Acentra Health is seeking an experienced and driven Clinical Quality Manager to join our growing team. In this critical leadership role, you will play a key part in ensuring clinical excellence and operational integrity within our Colorado Utilization Management (UM) and Physician Administered Drug (PAD) programs. Reporting to the Program Director and partnering closely with the Medical Director and administrative leadership, the Clinical Quality Manager provides strategic oversight of all clinical training and quality assurance activities supporting the Health First Colorado Utilization Management contract. You will play a critical role in ensuring regulatory compliance, strengthening clinical performance, and advancing a culture of continuous quality improvement. The Clinical Quality Manager also partners with cross-functional teams to inform system configuration requirements and drive reporting enhancements that support efficient clinical operations, data integrity, and performance transparency. This is an exceptional opportunity for an accomplished clinical quality leader who is passionate about improving healthcare outcomes, developing high-performing clinical teams, and leading impactful, quality-driven initiatives within a mission-focused organization committed to excellence. Responsibilities • Provide strategic leadership to ensure the program consistently meets or exceeds all contractual performance standards, regulatory requirements, and quality benchmarks, driving measurable improvements in outcomes and compliance. • Partner with the Program Director, Utilization Management Manager, and clinical supervisors to lead enterprise-level quality monitoring activities, leveraging data analysis to identify performance gaps, prioritize improvement initiatives, and design, implement, and track corrective action plans with defined metrics and timelines. • Oversee the contract-specific Quality Management Program, providing expert guidance and strategic direction to internal leadership teams and external clients on all quality-related matters. • Manage and oversee Interrater Reliability (IRR) reviews and clinical documentation audit processes to ensure accuracy, compliance, and clinical integrity. • Lead quality assurance efforts with a focus on risk management, operational effectiveness, infrastructure optimization, performance measurement, continuous improvement, and consumer protection and empowerment. • Partner collaboratively with clients and key stakeholders to design, deliver, and refine training initiatives and process improvements that enhance performance and quality outcomes. • Serve as a clinical quality resource by consulting with program managers and supervisors on member and provider complaints, appeals, and grievances, as needed. • Read, understand, and comply with all corporate policies and procedures, including strict adherence to HIPAA Privacy and Security Rules and all applicable confidentiality standards. • The above list is not intended to be all-inclusive and may be expanded to include other duties that the management may deem necessary from time to time. Qualifications: Required Qualifications, Knowledge, and Experience • Bachelor of Science in Nursing (BSN) required; Master of Science in Nursing (MSN) preferred. • Active, unrestricted Nurse (RN) license or a valid multistate compact RN license, maintained in good standing. • Minimum of 3 years of progressive experience leading or supporting clinical quality, utilization management, or performance improvement initiatives within a Medicaid, managed care, or regulated healthcare environment, with demonstrated success meeting quality, compliance, and audit performance standards. • Minimum of 2 years of experience recommending, developing, and reviewing quality assurance standards, policies, and procedures in alignment with organizational and regulatory requirements. • Minimum of 2 years of experience in data collection and analysis, process improvement initiatives, quality measure and metric management, and the development of templates and materials for public notices, training programs, and surveys. Preferred Qualifications and Experience • Proven senior-level leadership capabilities, including the ability to establish high performance expectations, drive accountability, and lead teams to achieve measurable quality, compliance, and operational outcomes. • Working knowledge and practical application of Utilization Review Accreditation Commission (URAC) standards, with experience supporting accreditation readiness, regulatory audits, and ongoing compliance activities. • Ability to lead effectively in complex, fast-paced environments, managing competing priorities, regulatory deadlines, and operational demands while maintaining quality and excellence. • Preferred experience and working knowledge of Health First Colorado systems and processes. • Strong track record of using data, dashboards, and performance metrics (e.g., audit scores, turnaround times, compliance rates, corrective action closure) to assess performance, identify risk, and drive continuous quality improvement. • Commitment to serving as a clinical quality subject matter expert and thought leader, providing strategic guidance and influence across programs, leadership teams, and external stakeholders. • Excellent verbal and written communication skills, with the ability to translate complex clinical, regulatory, and quality concepts into clear, actionable insights for diverse audiences. • Highly organized, detail-oriented leader with strong project management skills and the ability to manage multiple initiatives while meeting contractual and regulatory timelines. • Strong customer and stakeholder focus, with demonstrated success in building trusted relationships, resolving issues proactively, and improving satisfaction and performance outcomes. • Advanced proficiency in arenaflex Office Suite, including the ability to analyze trends, develop executive-level reports, and present quality and performance findings to senior leadership and clients. Why us We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career. We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! EOE AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The compensation for this role is $81,280.00 - $95,000.00 annual base salary Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level. #LI-JS1 Pay Range: Starting from USD $81,280.00/Yr. Apply tot his job Apply tot his job