Quality Care Manager

Job Description

Job Description

Locations: Tallahassee, FLDepartment: Clinical Quality & Performance Improvement F/T or P/T status: Full-timeSchedule: As requiredAbout the role: We are seeking a Quality Care Manager to support Capital Health Plan's clinical quality, patient safety, and performance improvement efforts. This role analyzes qualitative and quantitative data, conducts clinical reviews, and prepares reports related to performance measures, quality outcomes, and patient safety.The Quality Care Manager plays a key role in coordinating peer review activities, conducting medical record reviews, supporting quality audits, and ensuring compliance with NCQA, CMS, and State of Florida requirements. This position also serves as a resource across the organization by providing consultation on quality improvement, best practices, accreditation standards, and performance measurement initiatives.We're looking for someone who has: Bachelor's degree in nursing or a bachelor's degree in a clinical field from an accredited four-year college or universityClinical licensure in the State of FloridaMinimum of three years of experience working in a clinical healthcare setting preferredExperience conducting clinical reviews, audits, or quality investigationsAbility to analyze and interpret qualitative and quantitative clinical dataStrong written and verbal communication skills, including preparation of reports and presentationsAbility to coordinate and maintain documentation to support accreditation and regulatory complianceProficiency with computer applications, including word processing, spreadsheets, databases, and web-based toolsHighly preferred candidates also have: Experience with quality improvement programs, performance measurement, or accreditation activitiesFamiliarity with NCQA standards, CMS Part C and D requirements, and state regulatory requirementsExperience conducting peer review activities or quality of care investigationsStrong data analysis and reporting experience related to clinical outcomes and patient safetyAbility to manage complex quality projects and meet regulatory reporting deadlinesAre Certified Professional in Healthcare Quality (CPHQ)About Capital Health Plan (CHP):CHP is a locally based, not‑for‑profit health maintenance organization serving the Tallahassee region for more than four decades. Founded by community leaders with a mission to deliver high‑quality, affordable, and patient‑centered health care, CHP has grown into a nationally recognized healthcare organization while remaining deeply rooted in the communities it serves.CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.