Senior Manager, Quality Improvement

Job Description: • Oversee Regulatory QI Program Elements: lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan, ensure timely completion of annual QI Program Evaluation, manage QI Committee activities. • Regulatory Compliance & Audit Readiness: ensure CMS, NCQA, and state QI requirements are met, maintain audit readiness for CMS Program Audits, partner with Legal and Compliance teams. • Quality of Care Oversight: oversee Quality of Care investigations, collaborate with Medical Directors and clinical teams.

• Performance Monitoring & Improvement: support Star Ratings strategy, present QI outcomes, implement cross-functional improvement initiatives. • Leadership & Collaboration: supervise QI professionals, lead cross-departmental working groups, foster a culture of quality, compliance, and continuous improvement. Requirements: • Active, unrestricted RN license (required). • Bachelor’s degree in Nursing or a related field (Master’s preferred). • Minimum 3 years of experience in Medicare Advantage or similar managed care setting.

• Deep knowledge of CMS MMCM Chapter 4 (Benefits & Beneficiary Protections) and Chapter 5 (Quality Improvement Program) requirements. • Experience in regulatory compliance, QI program oversight, and audit readiness. • At least 3 years of leadership experience, including direct team management. • Strong skills in data analysis, performance monitoring, and process improvement. • Proficiency with bolthires Office and bolthires Suite. • Excellent written and verbal communication skills; ability to present to executive leadership and committees.

Benefits: • Financial Well-Being: competitive base salary and equity opportunities, performance-based bonus program, 401k matching, regular compensation reviews. • Physical Well-Being: comprehensive medical, dental, and vision coverage. • Mental Well-Being: initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, generous flexible time-off policy, remote-first culture supporting collaboration. • Professional Development: learning programs, mentorship, professional development funding, regular performance feedback and reviews.

• Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, paid parental leave for all new parents. Apply tot his job

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