Quality Management Director (Remote in California)

Summary

The Quality Management Director serves a critical function providing review and monitoring of services provided by Gainwell on the Medi-Cal account.  The position is responsible for the quality management program and is the primary point of communication with the client.  The position will use deep healthcare claims processing and Medi-Cal policy knowledge to ensure compliance.  The position provides day-to-day directions to a small team in a matrixed organization structure.   

Your role in our mission

• As a member of the account management team will work to set the strategy and vision for the account’s Quality Management activities including Quality Assurance, Quality Control and reporting.
• Responsible for communication and coordination across all Business Services across the account’s operations, as well as communication with the client.
• Plays a critical role in providing data, direction on operational procedures, and procedure manuals with a focus on flow and inclusion of quality processes and measurement.
• Provides structure, methodologies and direction for root cause analysis, corrective actions and ongoing process improvements.
• Under minimal supervision, using independent professional judgement, respond to inquiries from clients, and internal stakeholders with professionalism and accuracy.  Manage all account quality management activities as well as provide leadership and support to the quality management team.

What we're looking for

• Must possess a Bachelor’s degree and a minimum of four (4) years of quality management (QM) experience (additional relevant management experience may substitute for the degree on a year-for-year basis).
• Quality Management experience shall be specific to a large-scale healthcare payer operation with an emphasis on customer and service delivery.
• Two (2) years of Medicaid Management Information System (MMIS) or government, or private sector healthcare payer experience.
• Strong analytical, communication, and organizational skills with the ability to manage multiple priorities; including project management capabilities, conducting root-cause analysis and process improvement.
• Excellent leadership and management skills to provide direction to and engage with both local and leveraged quality team members.

What you should expect in this role

• Must be a resident of the state of California.
• Willingness to travel to the office as requested.  Employees working-from-home may be required to report to the office, at times, to support meetings, special quality-focused requests or other business needs. The office is in West Sacramento.
• This is a full-time permanent regular salaried (W-2) employee position.
• Monday through Friday work schedule.
• Health (medical, dental, vision) benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer for work use. For all hybrid and remote positions employees' Broadband Internet connections should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• This position will remain posted until it is filled or January 31, 2026, which ever comes first. Applying does not guarantee an interview.

#LI-NB1

#LI-HYBRID