Manager, Clinical Education & Quality (Healthcare)

TL;DR

Manager, Clinical Education & Quality (Healthcare): Developing and overseeing regulatory compliance, quality assurance, and training programs for Care Management functions with an accent on NCQA and URAC accreditation standards. Focus on designing formal training curricula, conducting clinical audits, and ensuring operational excellence across UM and CM workflows.

Location: California, United States

Salary: $91,520 - $106,000

Company

hirify.global is a personalized health platform providing health plan administration, holistic wellbeing solutions, and comprehensive care navigation.

What you will do

• Lead the development and implementation of regulatory compliance and quality assurance programs for Care Management functions.
• Design and deliver formal training curricula for clinical and non-clinical staff using various modalities including virtual and live sessions.
• Conduct routine file audits and quality reviews to ensure adherence to state, federal, and accreditation requirements (NCQA, URAC).
• Analyze trends from audits, complaints, and quality data to identify systemic risks and improvement opportunities.
• Manage internal and external audits, including the preparation of evidence files and corrective action plans.
• Collaborate with operational leaders to translate complex regulatory requirements into operational guidance and workflows.

Requirements

• Active, unrestricted Registered Nurse (RN) license required.
• Must be based in California, United States.
• Experience in managed care, Care Management, Utilization Management (UM), or quality/compliance support.
• Knowledge of medical claims and ICD-10, CPT, and HCPCS coding.
• Proficiency in Microsoft Office (Word, Excel, Outlook) and experience with VPN, SharePoint, and similar enterprise tools.
• Strong verbal and written communication skills for interacting with leadership and staff.

Nice to have

• Bachelor's or advanced degree.
• Relevant professional certifications such as CPHQ or CCM.
• Experience in designing and delivering staff training programs.

Culture & Benefits

• Unlimited PTO to ensure rest and recharge time.
• Comprehensive medical and dental insurance effective from day one.
• Professional development opportunities with dedicated learning budgets and clear career progression.
• Mental health support, retirement planning, and financial protection.
• Mission-driven culture that values diverse perspectives to improve health outcomes.