Manager, Quality Practice Advisor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager, Quality Practice Advisor based in United States.

This role provides leadership across clinical quality, quality improvement, and risk adjustment initiatives within a managed care environment.
You will help shape programs that improve the quality of care, support better health outcomes, and identify opportunities to reduce costs.
The position combines people leadership, clinical program oversight, provider engagement, and performance analysis.
You will use quality data and reporting to identify trends, prioritize opportunities, and recommend meaningful interventions.
The role also plays an important part in physician education, regulatory readiness, and continuous performance improvement.
Success requires strong collaboration across clinical, quality, pharmacy, risk, and provider-facing teams.
This is an opportunity to influence healthcare delivery while developing teams and driving measurable improvements in quality and performance.

Accountabilities:

• Lead and provide direction for clinical, quality, and risk adjustment functions, ensuring programs support improved member outcomes, quality of care, and cost effectiveness.
• Develop and oversee clinical programs focused on physician education, provider communication, quality improvement, and risk adjustment opportunities.
• Partner with cross-functional departments to prioritize provider engagement activities and coordinate clinical, quality, and risk adjustment initiatives.
• Establish and maintain tracking, monitoring, and reporting systems for healthcare quality improvement activities in line with regulatory requirements, policies, procedures, risk adjustment standards, and contractual commitments.
• Monitor high-risk, high-volume, and unusual events through concurrent and retrospective review, ensuring appropriate follow-up and corrective action.
• Analyze performance reports and quality data to identify trends, gaps, opportunities, and recommended actions.
• Lead and evaluate team performance, providing direction, coaching, training, and professional development to department associates.
• Coordinate quality guidelines, studies, and performance improvement initiatives alongside quality management, pharmacy services, and risk management programs.
• Maintain strong knowledge of HEDIS requirements and translate clinical performance insights into initiatives designed to improve HEDIS results.
• Coordinate external programmatic oversight visits for contracted providers, ensuring required activities, documentation, follow-up, and corrective action plans are completed on schedule.

Requirements

• Bachelor’s degree in Healthcare, Nursing, Public Health Administration, Business, or a related discipline; equivalent relevant professional experience may also be considered.
• At least 3 years of supervisory or management experience, with demonstrated ability to lead, coach, and develop teams.
• 5+ years of experience working in a managed care environment.
• Strong understanding of clinical quality improvement, healthcare performance management, risk adjustment, and provider engagement.
• Working knowledge of HEDIS requirements and quality performance improvement methodologies.
• Experience using reports, data, and performance metrics to identify trends, evaluate opportunities, and support evidence-based decisions.
• Strong organizational, analytical, critical-thinking, and problem-solving skills, with the ability to manage multiple priorities and deadlines.
• Excellent communication and collaboration skills, including the ability to work effectively with clinical, operational, provider, and cross-functional stakeholders.
• Demonstrated ability to provide guidance and training while fostering accountability, continuous improvement, and professional development.
• Preferred credentials include Registered Nurse (RN), Certified Health Care Risk Management certification, Foreign Medical Doctor (MD), or American Academy of Professional Coders (AAPC) certification.
• Ability to work effectively in a remote environment while maintaining strong stakeholder engagement and team leadership.

Benefits

• Annual salary range of $87,700 – $157,800 , with actual compensation determined by factors such as skills, experience, education, job-related qualifications, and work status.
• Potential additional incentive compensation as applicable.
• Medical and other health insurance benefits.
• 401(k) and stock purchase plan opportunities.
• Tuition reimbursement and professional development support.
• Paid time off and holidays.
• Flexible work arrangements, including remote, hybrid, field, or office-based options depending on role and business needs.
• A purpose-driven environment focused on improving healthcare access, quality, and outcomes.
• Benefits are subject to applicable eligibility requirements and program terms.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.