ACO Quality Manager
- Hiring from
- United States
- Work type
- Remote
- Posted
Is this job info correct?
544,298 remote jobs, straight from company career pages
100% free · New jobs every hour
Show job descriptionHide job description
The ACO Quality Manager is a Registered Nurse responsible for supporting quality performance across Medicare accountable care programs, including the Medicare Shared Savings Program, ACO REACH, and successor models such as LEAD. This role combines clinical expertise, quality-measure knowledge, data analysis, medical-record auditing, provider education, and training program development to improve documented care delivery and organizational performance.
The ACO Quality Manager reviews clinical and claims-based data, identifies care and documentation gaps, validates measure compliance through medical-record review, and works directly with providers and clinical teams to improve quality outcomes. The ideal candidate understands value-based care and can translate complex CMS requirements and performance data into engaging, practical, and actionable education.
Key Responsibilities:
- Monitor organizational performance against applicable MSSP, ACO REACH, LEAD, and other CMS quality measures and reporting requirements.
- Interpret quality-measure specifications, technical guidance, reporting requirements, and CMS program updates.
- Analyze clinical, claims, pharmacy, laboratory, and supplemental data to identify quality gaps, documentation deficiencies, utilization trends, and improvement opportunities.
- Conduct medical-record audits to validate measure compliance, clinical documentation, coding accuracy, and supporting evidence.
- Perform targeted chart reviews for preventive care, chronic disease management, transitions of care, medication reconciliation, and other applicable quality measures.
- Reconcile quality data across electronic health records, population health platforms, claims files, registries, and provider-submitted documentation.
- Investigate discrepancies between reported performance and supporting medical-record documentation.
- Develop and maintain audit tools, measure-specific workflows, validation procedures, and quality-performance tracking reports.
- Provide clear, actionable feedback to physicians, advanced practice providers, nurses, practice managers, and other clinical personnel.
- Develop and execute comprehensive training programs across live, virtual, and e-learning platforms.
- Design engaging educational content, presentations, webinars, recorded modules, job aids, assessments, and other learning resources.
- Deliver professional presentations and training sessions to providers, clinical teams, operational leaders, and other stakeholders.
- Evaluate training effectiveness, knowledge retention, learner engagement, and the impact of education on quality performance.
- Train providers and staff on quality-measure requirements, documentation standards, evidence-based care expectations, and methods for closing care gaps.
- Adapt training content and delivery methods to meet the needs of different audiences, clinical settings, and levels of experience.
- Support prospective and retrospective quality-improvement initiatives across participating practices and facilities.
- Collaborate with analytics, clinical operations, compliance, coding, care management, provider-engagement, and learning and development teams.
- Assist with quality-data submission, validation, reconciliation, and audit-readiness activities.
- Track corrective actions and follow-up activities resulting from chart audits, data reviews, or identified performance deficiencies.
- Identify barriers to quality performance and recommend practical workflow, documentation, technology, or educational improvements.
- Support provider performance meetings by preparing reports, summarizing findings, and presenting improvement recommendations.
- Maintain current knowledge of CMS accountable care models, quality methodologies, measure changes, reporting deadlines, and regulatory requirements.
- Protect beneficiary information and perform all responsibilities in accordance with HIPAA, organizational privacy policies, and applicable regulatory requirements.
Qualifications
- Active and unrestricted Registered Nurse license.
- Bachelor of Science in Nursing or equivalent combination of nursing education and relevant experience.
- Experience working with Medicare accountable care or value-based care programs, including MSSP, ACO REACH, LEAD, or comparable risk-based models.
- Working knowledge of CMS quality measures, measure specifications, clinical documentation requirements, and quality-reporting methodologies.
- Experience conducting medical-record audits, chart abstraction, or clinical documentation reviews.
- Demonstrated ability to analyze healthcare data and translate findings into actionable clinical recommendations.
- Experience developing and delivering education for physicians, advanced practice providers, nurses, practice managers, or other healthcare professionals.
- Experience creating and executing training through live, virtual, and e-learning platforms.
- Excellent presentation and facilitation skills, with the ability to communicate complex clinical, analytical, and regulatory information clearly and confidently.
- Strong understanding of preventive care, chronic disease management, care transitions, and population health principles.
- Proficiency with electronic health records, population health platforms, Microsoft Excel, presentation software, and quality-performance reporting tools.
- Excellent written and verbal communication skills.
- Strong attention to detail, critical-thinking ability, and professional judgment.
- Ability to manage multiple priorities and meet regulatory and operational deadlines.
Preferred Qualifications
- Three or more years of clinical nursing experience.
- Two or more years of experience in MSSP, ACO REACH, LEAD, Medicare Advantage or other value-based care quality and population health analytics.
- Experience supporting quality initiatives involving Medicare beneficiaries, medically complex populations, long-term care residents, or skilled nursing facility populations.
- Familiarity with claims-based quality measures, electronic clinical quality measures, CAHPS, MIPS, health equity requirements, and CMS audit processes.
- Experience working with CCLF data or other Medicare claims and beneficiary-level data.
- Experience with learning-management systems, webinar platforms, or e-learning authoring tools.
- Experience with Power BI, Tableau, SQL, or comparable healthcare analytics tools.
- Certified Professional in Healthcare Quality, Certified Professional Coder, or other relevant quality, coding, education, or informatics certification.
Core Competencies
- ACO quality-measure expertise
- Clinical data interpretation
- Medical-record auditing
- Chart abstraction and validation
- Quality-gap identification
- Provider education and engagement
- Training-program development and execution
- Live and virtual training facilitation
- E-learning content development
- Professional presentation skills
- Clinical documentation improvement
- Healthcare data analytics
- Performance reporting
- Corrective-action monitoring
- Regulatory interpretation
- Cross-functional collaboration
- Clear and concise communication
- Accuracy and attention to detail
Success Measures
Performance in this role will be evaluated based on:
- Accuracy and timeliness of medical-record audits and quality reporting.
- Improvement in quality-measure performance and care-gap closure.
- Reduction in documentation and data-validation discrepancies.
- Quality, effectiveness, and reach of live, virtual, and e-learning programs.
- Training participation, learner engagement, knowledge retention, and adoption of recommended practices.
- Effectiveness of presentations and provider education.
- Timely completion of corrective actions and follow-up activities.
- Readiness for CMS, payer, or internal quality audits.
- Ability to convert clinical and analytical findings into measurable operational improvements.