Manager, Quality

Overview

As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home.

It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

We foster an inclusive work environment that promotes collaboration and innovation at every level. Our values bring our mission to life and serve as the DNA for every decision we make:

• Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.
• Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.
• Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests.
• Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions.
• Tenacity: We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners.

We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including:

• Subsidized, personal healthcare coverage (medical, dental vision)
• Flexible Paid Time Off (PTO)
• Professional Development, CEU, and Tuition Reimbursement
• Curated Wellness Benefits supporting teammates physical and mental well-being
• Community engagement opportunities
• And more!

The Manager, Quality, reporting to the Director, Quality, is responsible for supporting the establishment of an effective quality improvement program essential to meet NCQA requirements, state specific requirements, and CMS guidelines. This role provides guidance and oversight to all lines of business including Commercial, Medicaid, Medicare, and Special Need Plans (SNPs). The Manager, Quality will work closely with Director and Accreditation Team to ensure compliance with audits, complaints/grievances, and adherence to contractual obligations and Service Level Agreements to maintain high-quality standards and regulatory requirements.

• Oversee new client and CMS delegation audits, and annual client audits
• Direct, implement, and monitor internal and external audit protocols to drive continuous quality improvement and ensure compliance with regulatory and organizational standards.
• Support the development and execution of the overall quality strategy aligned with organizational goals in conjunction with Director, AVP and SVP.
• Maintain up to date knowledge of regulatory changes and ensure implementation across the organization, by facilitating cross-functional meetings when necessary.
• Support patient experience and patient safety programs with the support of the Director of Quality.
• Work with operations and management to develop strategic performance improvement plan and work plan goals for internal and external audits results.
• Ensure compliance with applicable regulatory standards and service level agreements by overseeing the review and investigation of incident reports, complaints and grievances, and member and/or staff injuries to identify and develop improvement opportunities.
• Develop, track and report key quality performance indicators to measure the effectiveness of programs and identify improvement opportunities.
• Support information presented to committees as directed, such as, the Quality Committee, Clinical Enterprise Sub-Committee, Clinical Sub-Audit Committee, and Compliance Committee.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

• Bachelor’s Degree…