healthcare quality manager

Medical Billing Diploma Program - Riphah International University

<div>
 Job Description (
 
 total positions: 1, posted on: Nov 3, 2025
 
 )
 
 
 Riphah Institute of Healthcare Improvement and Safety, seeking the Senior Manager provides leadership for planning and operational oversight for executing institutional projects, activities and initiatives at RIHIS. The role includes planning, budgeting, program development, stakeholder engagement, research supervision, training, audits, and managing large-scale events such as the International Conference on Patient Safety (ICPS). The Senior Manager ensures that RIHIS maintains excellence in healthcare quality improvement, patient safety advocacy, and academic contributions nationally and internationally.
 
 
 
 Requirements
 
 
 
 <ul>
 <li>
 MBBS (preferred) / BDS / PharmD. Masters/MS (required) or higher in Healthcare Management, Public Health, Quality, or Safety, MBA in Healthcare Management (preferred).
 </li>
 <li>
 CPHQ or C++S, Lead Auditor (ISO/MSDS), Project Management.
 </li>
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 Minimum 8 years in healthcare or hospital management, including leadership roles.
 </li>
 <li>
 Minimum 5 years experience in healthcare quality and patient safety (preferred).
 </li>
 <li>
 Clinical experience of at least 3 years in a healthcare setting (preferred).
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Develop and execute RIHISs annual operational and strategic plans in line with institutional goals.
 </li>
 <li>
 Lead initiatives, audits, and assessments based on ISO, MSDS, and global patient safety standards; oversee development of improvement plans.
 </li>
 <li>
 Co Design, lead, and supervise research projects on healthcare quality and patient safety; ensure data integrity, compliance, and dissemination of findings.
 </li>
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 Develop and deliver training programs, toolkits, and workshops for healthcare professionals across all levels.
 </li>
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 Act as focal person for communication, coordination, and collaboration with internal teams, government bodies, academic institutions, and international partners.
 </li>
 <li>
 Develop proposals, secure approvals/funding, and oversee successful implementation of quality and safety programs.
 </li>
 <li>
 Lead planning, execution, and evaluation of ICPS and other institutional seminars, workshops, and outreach activities.
 </li>
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 Oversee communication, publications, and digital outreach (website, social media, newsletters).
 </li>
 <li>
 Develop, monitor, and manage departmental budgets, ensuring optimal utilization of resources.
 
 
 </li>
 </ul>
 
 Required Skills
 
 
 
 Healthcare Quality Improvement, Patient safety management, clinical governance, Regulatory Compliance, Hospital Management, Clinical Experience,
 
 
 
 Industry
 
 
 
 Education/Training
 
 
 
 Job Type
 
 
 
 Full Time/Permanent
 
 
 
 Gender
 
 
 
 No Preference
 
 
 
 Minimum Experience
 
 
 
 8 Years
</div>

Senior Manager Healthcare Improvement and Safety

Estithmar Holding

<div>
 
 The role incumbent is responsible for auditing clinical and administrative processes to ensure adherence to healthcare quality standards, patient safety protocols, and regulatory compliance in a hospital setting. The role supports continuous quality improvement initiatives, risk management, and ensures that hospital practices align with national and international accreditation standards.
 
 
 
 Key Responsibilities:
 
 
 
 
 1. Quality Assurance &amp; Clinical Audits
 
 
 <ul>
 <li>
 Conduct regular audits of clinical departments to assess compliance with evidence-based practices, clinical guidelines, and hospital policies.
 </li>
 <li>
 Analyze patient records, documentation, and outcomes to identify gaps in care or areas.
 </li>
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 Identify risks and opportunities for improvement in patient care processes.
 </li>
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 Evaluate adherence to hospital-wide quality metrics and KPIs.
 </li>
 <li>
 Monitor and report on key performance indicators (KPIs) related to quality and safety.
 </li>
 </ul>
 
 
 2. Patient Safety
 
 
 <ul>
 <li>
 Audit incident reports and investigate adverse events, near-misses, and sentinel events.
 </li>
 <li>
 Audit implementation of patient safety programs and protocols (e.g. hand hygiene, medication safety, surgical safety).
 </li>
 <li>
 Review and assess hospital compliance with national patient safety goals (e.g. WHO, JCI, or local health authority standards).
 </li>
 </ul>
 
 
 3. Compliance &amp; Accreditation
 
 
 <ul>
 <li>
 Ensure hospital practices align with national and international standards (e.g., MoPH, JCI, ISO)
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 Perform compliance audits on medical records, infection control, consent processes, and other regulated areas.
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 Review environmental safety measures.
 </li>
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 Audit documentation, incident reports and corrective actions for regulatory compliance.
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 </ul>
 
 
 4. Reporting &amp; Documentation:
 
 
 <ul>
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 Prepare detailed audit reports with findings, risk assessments and recommendations.
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 Track corrective actions and verify their implementation and effectiveness.
 </li>
 <li>
 Present findings to hospital leadership and line manager.
 </li>
 </ul>
 
 
 Qualifications:
 
 
 <ul>
 <li>
 
 Education:
 
 Bachelor&rsquo;s degree in Nursing or Medical degree, Health Sciences, Healthcare Administration, or related field (Master&rsquo;s preferred).
 </li>
 <li>
 
 Certifications:
 
 </li>
 <li>
 Patient Safety Certification (e.g. CPPS) is a plus
 </li>
 <li>
 Internal Auditor Certification (ISO or equivalent) preferred
 </li>
 <li>
 
 Experience:
 
 </li>
 <li>
 Minimum 3&ndash;5 years of experience in quality management, clinical auditing, or healthcare compliance.
 </li>
 <li>
 Experience in a JCI-accredited hospital or healthcare setting is an advantage.
 </li>
 </ul>
 
 
 Skills &amp; Competencies:
 
 
 <ul>
 <li>
 Strong knowledge of healthcare quality standards and patient safety principles
 </li>
 <li>
 Strong understanding of healthcare risk management
 </li>
 <li>
 Familiarity with accreditation frameworks (e.g. JCI, ISO, local health authority)
 </li>
 <li>
 Analytical and detail-oriented with excellent report writing skills
 </li>
 <li>
 Strong communication and interpersonal skills
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 Ability to manage multiple audits and prioritize tasks
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 Proficient in Microsoft Office, audit tools, and healthcare data systems
 </li>
 </ul>
</div>

Director Audit and Compliance – Clinical & Patient Safety

Sanford Health

Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Facility: GSS National Campus Location: Sioux Falls, SD Address: 4800 W 57th St, Sioux Falls, SD 57108, USA Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Job Summary Responsible for providing clinical administrative leadership and expertise to departments and practice operations. Develops and monitors appropriate clinical, satisfaction, and administrative outcome indicators for quality and continuous improvement. Responsible for providing professional, technical, and clinical expertise. Possesses major responsibility for implementing the vision and mission, plan and standards of the organization and the Care Management department. Contributes to the strategic planning process, day-to-day operations, and attainment of goals of the organization. Responsible for the maintaining communication and for the contextual environment in which clinical services are delivered across the organization. Actively participates in tasks force, committees, board meetings, etc. to assist with the overall organizational goals and strategic initiatives. Knowledgeable of governing bodies, budgeting, accreditation, and contracts. Review and consult on final strategic plans in collaboration with leadership. Collaborates with other health systems as necessary. Ability to carry out strategies and tasks and support the mission and goals of the organization. Develops trusting relationships with personnel, clinical professionals, other leadership, and multi-disciplinary departments in a professional attitude. Understanding of current and potential team capabilities and ability to clarify performance targets and objectives to drive project and process improvement strategies. Knowledge of human resources and personnel management processes; ability to lead, motivate, evaluate, and reward personnel at the work place. Qualifications Bachelor's degree in Nursing is required. Master's degree in Nursing or related area is preferred. Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Previous experience in case management is required. Management, leadership, Healthcare Effectiveness Data and Information Set (HEDIS), and accreditation is preferred. Minimum of 5 years nursing experience is required. Currently licensed with the applicable state nursing board and/or possess multistate licensure privileges as required by position (e.g. home state licensure and also Minnesota licensure) is required. Current Commission for Case Manager Certification (CCMC) is preferred or is to be obtained within 18 months of employment. Certified Professional in Healthcare Quality (CPHQ) certification is preferred. Benefits Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit . Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1- or send an email to . Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment. Req Number: R- Job Function: Health Plan Featured: No

Director, Care Management, Health Plan

CVS Health

<div>At CVS Health, we&rsquo;re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation&rsquo;s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues &ndash; caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
This position will be working from home anywhere in the continental US.
Standard business hours Monday-Friday.<ul><li>
Accountable for conducting oversight of entities that are contracted to perform clinical functions on Aetna's behalf.</li><li>
Monitor and track delegated entities compliance with regulatory and NCQA requirements.</li><li>
Communicate to delegated entities about industry standards, Aetna policies, and best practices.</li><li>
Accountable for preparing delegation oversight resources for NCQA and regulatory reviews</li><li>
This position supports NCQA, CMS, and other regulatory compliance initiatives.</li></ul> 
Required Qualifications<ul><li>
3&ndash;5 years of experience in Quality Management within the healthcare industry</li><li>
Demonstrated ability to consistently meet deadlines in a fast-paced environment</li><li>
Strong communication and interpersonal skills, with a proven ability to collaborate effectively across teams</li></ul> 
Preferred Qualifications<ul><li>
2 to 3 years prior experience working in Commercial/Medicare or Medicaid lines of business</li><li>
Medical Terminology and Claims Experience</li><li>
QuickBase Experience</li><li>
Experience with flexing and shifting priorities</li><li>
Experience working independently and collaboratively to solve problems, make decisions, and complete work/projects</li><li>
Growth mindset (developing yourself and others) skills</li></ul> 
Education<ul><li>
Bachelors Degree Preferred</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$43,888.00 - $102,081.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul><li>
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li></ul>
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 11/21/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Analyst, Health Care Quality Management - Work at Home

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