<h2>Overview</h2> <p><strong>Who We Are</strong></p> <p><strong>Because health is personal.</strong> That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.</p> <p>Learn even more about the work that drives us at personifyhealth.com.</p> <h2>Responsibilities</h2> <p><strong>Ready To</strong></p> <p> </p> <p><strong>What You'll Actually Do</strong></p> <p> </p> <p><strong>ESSENTIAL DUTIES AND RESPONSIBILITIES:</strong></p> <p> </p> <p>The Care Management Manager of Education & Quality is responsible for the development, implementation, and ongoing oversight of regulatory compliance, quality assurance, and training programs across Care Management functions, including Utilization Management (UM), Case Management (CM), and Population Health/Disease Management. This role ensures clinical and non-clinical staff are equipped to meet state and federal regulatory requirements, accreditation standards (NCQA, URAC), and organizational expectations, while supporting operational excellence and continuous quality improvement.</p> <p> </p> <p><strong>Level I – Manager, Compliance & Training (Operational Focus)</strong></p> <p><strong>Compliance & Quality</strong></p> <ul> <li>Support execution of established compliance, audit, and quality monitoring activities within Care Management programs.</li> <li>Conduct routine file audits, training audits, and quality reviews using standardized tools.</li> <li>Track, document, and report audit findings, corrective actions, and follow-up activities.</li> <li>Ensure training, quality, and audit documentation meets regulatory and accreditation requirements.</li> <li>Apply state, federal, NCQA, URAC, CMS, and ERISA requirements under supervision.</li> </ul> <p><strong>Training & Education</strong></p> <ul> <li>Deliver training using established curricula for clinical and non-clinical staff.</li> <li>Assist with onboarding education and ongoing refresher training.</li> <li>Apply adult learning principles to support learner engagement and retention.</li> <li>Maintain training records, attendance logs, and competency documentation.</li> </ul> <p><strong>Collaboration & Communication</strong></p> <ul> <li>Collaborate with Care Management leaders, trainers, and compliance staff on implementation activities.</li> <li>Escalate risks, gaps, or trends appropriately.</li> </ul> <p> </p> <p><strong>Level II – Manager, Compliance & Training (Program & Advisory Focus)</strong></p> <p><strong>Compliance & Quality</strong></p> <ul> <li>Lead compliance monitoring activities across UM, CM, and population health programs.</li> <li>Interpret regulatory and accreditation requirements and translate them into operational guidance, tools, and workflows.</li> <li>Manage internal audits and support external audits, including preparation of evidence files and corrective action plans.</li> <li>Analyze trends from audits, complaints, and quality data to identify systemic risk and improvement opportunities.</li> <li>Serve as a subject matter expert for Care Management regulatory requirements.</li> </ul> <p><strong>Training & Education</strong></p> <p> </p> <ul> <li>Design, implement, and evaluate formal training programs using multiple modalities (virtual, self-paced, live, 1:1).</li> <li>Conduct training needs assessments and gap analyses.</li> <li>Measure training effectiveness and adjust curricula based on outcomes and quality findings.</li> </ul> <p><strong>Leadership & Partnership</strong></p> <ul> <li>Provide consultation to operational leaders on compliance, quality, and training strategies.</li> <li>Participate in Quality Improvement Committee (QIC) activities as assigned.</li> <li>Mentor staff and contribute to skill development within the training/compliance team.</li> </ul> <p> </p> <p><strong>Senior Level – Senior Manager, Care Management Compliance & Training (Strategic Leadership Focus)</strong></p> <p> </p> <ul> <li>Provide enterprise-level leadership for Care Management compliance, quality, and education strategy.</li> <li>Ensure Care Management programs remain continuously audit-ready.</li> <li>Lead regulatory interpretation, impact assessment, and organizational response planning.</li> <li>Oversee development and annual evaluation of the Quality Management Program components related to Care Management.</li> <li>Represent Care Management in enterprise compliance initiatives and accreditation engagements.</li> </ul> <p> </p> <p><strong>Training & Workforce Strategy</strong></p> <p> </p> <ul> <li>Establish long-term training and competency frameworks aligned with organizational growth, automation, and regulatory change.</li> <li>Drive innovation in training delivery, measurement, and scalability.</li> <li>Ensure training programs support quality outcomes, staff readiness, and member experience.</li> </ul> <p><strong>Leadership & Influence</strong></p> <ul> <li>Lead and develop the compliance and training team, including performance management and succession planning.</li> <li>Advise senior leaders, Medical Directors, and executives on compliance risk, quality performance, and readiness.</li> <li>Foster a culture of continuous learning, accountability, and improvement.</li> </ul> <p> </p> <p><strong>KEY COMPETENCIES:</strong></p> <p>To work in the health industries and to work remotely, it has been demonstrated that those with computer skills work better in these remote job descriptions.</p> <h2>Qualifications</h2> <p><strong>What You Bring to Our Team</strong></p> <p> </p> <p><strong>Qualifications:</strong></p> <p> </p> <ul> <li>Basic computer literacy</li> <li>The ability to work on multiple screens, and proficient typing skills.</li> <li>Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook</li> <li>Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.</li> <li>Ability to work independently and utilize written resources to problem solve.</li> <li>After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in:</li> <li>Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado,Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet—there may be additional programs as it relates to particular job duties</li> <li>Knowledge of medical claims and ICD-10, CPT, HCPCS coding</li> <li>Excellent verbal and written communication skills for upward and downward conversations</li> </ul> <p><strong>Level I</strong></p> <ul> <li>Working knowledge of managed care operations and Care Management workflows</li> <li>Understanding of NCQA, URAC, CMS, ERISA, and state regulatory basics</li> <li>Attention to detail and strong documentation skills</li> <li>Effective verbal and written communication</li> <li>Proficiency with required systems and tools</li> </ul> <p><strong>Level II</strong></p> <ul> <li>Advanced understanding of Care Management regulatory and accreditation requirements</li> <li>Strong analytical and problem-solving skillsAbility to translate complex regulations into operational guidance and training</li> <li>Project management and prioritization skills</li> <li>Confidence presenting and advising leaders</li> </ul> <p><strong>Senior Level</strong></p> <ul> <li>Expert-level regulatory and accreditation knowledge</li> <li>Strategic thinking and systems-level problem solving</li> <li>Executive presence and influence</li> <li>Proven ability to scale compliance and training programs</li> <li>Strong leadership, mentoring, and change management capabilitie</li> </ul> <p><strong>Level I</strong></p> <ul> <li>Active, unrestricted Registered Nurse (RN) license required</li> <li>Minimum 2–4 years of experience in managed care, Care Management, UM, or quality/compliance support</li> <li>Experience delivering or supporting staff training preferred</li> </ul> <p><strong>Level II</strong></p> <ul> <li>Active, unrestricted RN license required</li> <li>Bachelor’s degree preferred</li> <li>Minimum 4–6 years of experience in Care Management compliance, quality, UM/CM, or training</li> <li>Demonstrated experience leading audits, training programs, or quality initiatives</li> <li>Relevant certifications preferred (CPHQ, CCM, etc.)</li> </ul> <p><strong>Senior Level</strong></p> <ul> <li>Active, unrestricted RN license required</li> <li>Bachelor’s degree required; advanced degree preferred</li> <li>6+ years of progressive leadership experience in managed care compliance, quality, and training</li> <li>Deep experience with NCQA/URAC surveys, CMS alignment, and multi-state regulatory oversight</li> <li>Proven leadership and strategic program development experience</li> </ul> <p> </p> <p><strong>Physical and Mental Requirements:</strong></p> <ul> <li>Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.</li> <li>Ability to maintain regular, punctual attendance.</li> <li>Ability to sit for 6-8 hours.</li> <li>Constant use of computer keyboard and mouse; repetitive use of both hands.</li> <li>Occasional to frequent twisting of neck; occasional bending of neck and at waist.</li> </ul> <p> </p> <p><em>This job description is not an exclusive or exhaustive list of all job functions that an employee in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of MedCom a Personify Health Company.</em></p> <p> </p> <p><strong>Benefits</strong></p> <p><strong> </strong></p> <p><strong>The Highlights:</strong></p> <ul> <li>Competitive base salary and benefits effective day one</li> <li>Comprehensive medical and dental through our own health solutions (yes, we use what we build)</li> <li>Unlimited PTO—rest and recharge time is non-negotiable</li> <li>Mental health support, retirement planning, and financial protection</li> <li>Professional development with clear career progression and learning budgets</li> <li>Mission-driven culture where diverse perspectives drive real impact on people's health</li> </ul> <p><strong>Want the full picture? </strong>Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.</p> <p><strong>Compensation:</strong> This position offers a base salary range of $91,520 - $106,000. depending on location, skills, and experience. You're eligible for our full benefits package starting day one.</p> <p> </p> <p><strong>Our Commitment: </strong>Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.</p> <p> </p> <p><strong>Stay Safe:</strong> Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.</p>