{"id":3836438,"url":"https://alion.io/job/wellsky-clinical-quality-program-manager","title":"Clinical Quality Program Manager","company":{"id":179706,"name":"WellSky","domain":"wellsky.com","url":"https://alion.io/company/wellsky","size_band":"501-1000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":{"grade":"B","score":84,"open_postings":5,"ghost_share":0,"stale_share":0.4,"repost_share":0.4,"time_to_fill_p50_days":25,"computed_at":"2026-11-07T05:47:08Z"}},"role":"Management","role_family":"Management","seniority":"middle","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"posting_text","remote_working_hours":null,"hiring_geo_confidence":"explicit","locations":["United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":null,"experience_years_min":4,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-11-05T21:12:33Z","employer_posted_date":"2026-11-05","last_verified_at":"2026-11-06T23:33:04Z","board_verified":true,"closed_at":null,"days_open":1,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":1},"description":"This job is responsible for ensuring compliance with WellSky's Utilization Management and Quality Improvement Program by serving as a clinical expert on state and federal regulations. The scope of this job includes analyzing and presenting data to establish best practices across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities.\nWe invite you to apply today and join us in shaping the future of healthcare!\nKey Responsibilities:\nFacilitate activities related to performance measurement and outcomes, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices.\nGenerate and validate reports to monitor performance across health plan contracts, ensuring accuracy and alignment with requirements.\nConduct regular audits of UM decisions, case documentation, turnaround times, and adherence to other CMS and NCQA requirements.\nUnderstand how the UM Program is driven by the NCQA UM standards to ensure UM Program meets all NCQA requirements for accreditation.\nPrepare and lead committee meetings on a monthly and quarterly basis, driven by NCQA requirements.\nPrepare detailed quality reports, identify and analyze trends, and present findings to leadership with actionable recommendations.\nSupport implementing corrective action plans when scoring variances occur.\nSupport quality improvement project initiatives.\nPrepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings.\nPerform other job duties as assigned.\nRequired Qualifications:\nAt least 4-6 years relevant work experience\nExperience leading quality improvement projects and committee work.\nBachelor's Degree or equivalent work experience\nPreferred Qualifications:\nActive, unrestricted license: RN, PT, OT or SLP, with a bachelor’s degree in a related field or a combination of education and experience that includes pertinent clinical experience and advanced working knowledge of CMS standards and guidelines.\nAt minimum, 1-2 years of working knowledge of NCQA UM accreditation standards.\nMust be able to prioritize, plan and handle multiple tasks and demands simultaneously, with competing deadlines.\nExcellent in manipulating and sorting data for analytics and reporting.\nPrior experience owning client compliance SLAs and ensuring success in meeting SLA requirements.\nJob Expectations:\nWilling to work additional or irregular hours as needed.\nMust work in accordance with applicable security policies and procedures to safeguard company and client information.\nMust be able to sit and view a computer screen for extended periods of time.\nTravel approximately 10%. \nWellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.\nHere are some of the exciting benefits full-time teammates are eligible to receive at WellSky:\nExcellent medical with Rx, dental, and vision benefits\nMental Health support through EAP\nGenerous paid time off, plus 13 paid holidays\n100% vested 401(K) retirement plans\nEducational assistance up to $2500 per year\nWellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace.\nApplicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.\nData Privacy Notice for Job Applicants and Teammates","description_format":"text","description_chars":4099,"description_truncated":false,"requirements":{"experience_years_min":4,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","optional":false},"security_clearance":false,"languages":[]},"benefits":["Retirement plans"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["EHR & Clinical Software","Practice Management Software","Care Coordination & Population Health"],"lifecycle":[{"event":"open","at":"2026-11-05T21:12:33Z"}],"visa":[{"country":"US","licensed_sponsor":true,"adverts_offering_sponsorship_24m":0,"sanctioned_now":false,"evidence":"H-1B filings in 12 months: 5 · green card filings: 2","filings_12m":5,"filings_prev_12m":17,"green_card_filings_12m":2,"median_offered_wage_usd":133214,"route":null,"cap_exempt":false,"checked_at":"2026-11-07T07:57:00+00:00","sources":["US Department of Labor: LCA disclosure data (H-1B, H-1B1, E-3)","US Department of Labor: PERM disclosure data (green cards)"],"filings_for_role_12m":0}],"liveness":{"score":90,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.903,"p_room":1,"age_days":1,"expected_fill_days":25,"reasons":["conf:6","velocity","win:early"],"computed_at":"2026-11-07T05:47:08Z"},"pay":null,"html_url":"https://alion.io/job/wellsky-clinical-quality-program-manager","json_url":"https://alion.io/job/wellsky-clinical-quality-program-manager.json","meta":{"generated_at":"2026-11-07T11:33:38Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":11845,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-08T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":179706},"rest":"https://alion.io/mcp/rest/get_company?id=179706"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fwellsky-clinical-quality-program-manager"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fwellsky-clinical-quality-program-manager"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fwellsky-clinical-quality-program-manager"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/wellsky-clinical-quality-program-manager\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fwellsky-clinical-quality-program-manager"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":3836438}},{"tool":"search_jobs","arguments":{"company":"wellsky.com","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":3836438},"note":"people open to offers who fit this vacancy"}],"note":"The same data through MCP tools: https://alion.io/mcp/open needs no sign-in (compact searches, postings, people); https://alion.io/mcp with an Alion account has everything. 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