Quality Consultant Senior

Quality Consultant Senior

Work from home within Oregon, Washington, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s dedicated team of Quality Consultants are living our mission to make health care easier and lives better. As a member of the Quality Management team, our Senior Quality Consultant develops and implements quality improvement programs related to clinical quality measurement and outcomes and assists in resolving deficiencies that impact plan compliance to regulatory accreditation standards and/or quality measurement. Ensures activities meet regulatory requirements of the state or product and reflects Cambia’s quality strategies, approaches and work plans – all in service of creating a person-focused health care experience.

Are you a passionate professional looking to make a meaningful impact in the healthcare industry? Do you have a drive to improve lives and create a person-focused healthcare experience? Then this role may be the perfect fit. 

What You Bring to Cambia: 

Qualifications:  

• Bachelor’s degree in business administration or related field

• 8 years of progressive experience in health care administration, quality, project leader or project support or equivalent combination of education and experience

• May require a valid state driver’s license

Skills and Attributes: 

• Knowledge of Medicare Stars program, quality improvement processes and performance measurement.

• Demonstrated ability to identify problems, develop solutions and implement a chosen course of action.

• Leadership skills with the ability to direct activities of others both individually and within a project team.

• Ability to organize, plan, prioritize and develop multiple projects within time constraints.

• Strong data abstraction and quantitative, qualitative and analytical skills.

• Experience working with diverse data types, such as HEDIS, Stars, claims, cost and utilization, CAHPS, and HOS.

• Experience synthesizing complex data sets.

• Experience in report writing with graphic and statistical elements.

• Knowledge of Medicare Advantage, HEDIS measures, and managed care operations.

• Excellent verbal and written communication skills including ability to communicate effectively across multiple areas and levels.

• Participation in successful NCQA accreditation process experience strongly preferred.

What You Will Do at Cambia:  

• Serves as the subject matter expert in Medicare Stars, quality improvement methodologies and HEDIS measures, providing guidance and support to business unit partners to drive quality excellence.

• Develops, maintains, and assists with quality program documents, including a standardized quality management plan, to ensure compliance with external regulatory and accreditation requirements and/or performance measurement requirements.

• Serves as a point of contact and subject matter expert for quality/accreditation standards and measurement requirements, collaborating with quality/accreditation entities, business partners, and internal stakeholders to ensure compliance and identify opportunities for improvement.

• Monitors and mitigates accreditation and measurement risks, compiling information for internal use, external audits, and maintaining relevant records.

• Retrieves data from internal systems to support ongoing activities, meet measurement requirements, and produce written reports and program evaluations with complex data for quantitative and qualitative analysis.

• Manages and coordinates quality work groups, including scheduling, workflows, and producing minutes, to support the Quality Program and reports to the quality committee and management.

• Works with clinical and operational areas to develop performance metrics, identify areas for improvement, and implement interventions or corrective action plans as needed, establishing tracking and monitoring systems for health quality improvement activities.

• Provides regular project status communications to leaders, handles complex quality initiatives, and offers related training to new team members and colleagues across the organization.

#LI- Remote

The expected hiring range for a Quality Consultant Senior is $91,800 - $124,200 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%.  The current full salary range for this role is $86,000 - $141,000.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:  

• Work alongside diverse teams building cutting-edge solutions to transform health care.  
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.  
• Grow your career with a company committed to helping you succeed. 
• Give back to your community by participating in Cambia-supported outreach programs.  
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.  

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: 

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. 
• Annual employer contribution to a health savings account.  
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. 
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). 
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). 
• Award-winning wellness programs that reward you for participation. 
• Employee Assistance Fund for those in need. 
• Commute and parking benefits. 

Learn more about our benefits. 

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.