Manager- Quality & Acc.

MAJOR RESPONSIBILITIES Support the business in achieving the goals of the Quality Department through the following responsibilities: Leads the Quality Management Program, including annual program evaluation, quality improvement initiatives, KPI development, performance monitoring, and implementation of continuous process improvements. • Identifies compliance, accreditation, contractual, and operational risks; conducts root cause analyses; develops corrective action plans; monitors effectiveness of interventions; and escalates significant issues as appropriate. • Develops, implements, and oversees quality audit programs for clinical and physician review activities, including IRR audits, adverse determination reviews, and data integrity audits, ensuring alignment with contractual, regulatory, and accreditation requirements. • Ensures audit findings are accurate, consistent, defensible, and supported by standardized methodologies, appropriate sampling techniques, and regulatory requirements. • Maintains expertise in utilization management workflows, policies, and operational processes to ensure meaningful oversight and auditing activities. • Partners with operations, clinical leadership, compliance, education, IT, and other stakeholders to resolve deficiencies, improve processes, and sustain corrective actions. • Maintains readiness for accreditation surveys, client audits, and regulatory reviews by monitoring changing requirements, updating policies and audit criteria, maintain