Quality Manager

WNS

. Lead the Quality Management Program, including annual evaluation, quality improvement initiatives, KPI development, performance monitoring, and continuous process improvements .

Posted 11/2/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $100,000 - $125,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Quality Management, Compliance, and Utilization Management within healthcare settings, with a strong focus on accreditation standards, performance improvement, and effective leadership of quality initiatives.

Highest-signal resume keywords

Utilization Management ExperienceQuality Management ExperienceURAC Accreditation KnowledgeNCQA Accreditation KnowledgeLeadership in Managed Care

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

KPI DevelopmentRoot Cause AnalysisCorrective Action PlanningQuality Audit ProgramsData Integrity AuditsPerformance MonitoringCompliance StandardsAccreditation StandardsFraud ReportingCredentialing Management

Soft Skills

LeadershipCommunicationCritical ThinkingOrganizational SkillsCollaboration

Certifications & Qualifications

Active RN License

Industry Keywords

HealthcareManaged CareMedicare RegulationsMedicaid RegulationsCMS Requirements

About the role

Key responsibilities & impact

Lead the Quality Management Program, including annual evaluation, quality improvement initiatives, KPI development, performance monitoring, and continuous process improvements
Identify compliance, accreditation, contractual, and operational risks; conduct root cause analyses; develop corrective action plans; monitor intervention effectiveness; and escalate significant issues
Develop, implement, and oversee quality audit programs for clinical and physician review activities, including IRR audits, adverse determination reviews, and data integrity audits
Ensure audit findings are accurate, consistent, defensible, and supported by standardized methodologies, sampling techniques, and regulatory requirements
Oversee utilization management workflows, policies, and operational processes for quality oversight and auditing
Partner with operations, clinical leadership, compliance, education, IT, and other stakeholders to resolve deficiencies and sustain corrective actions
Maintain readiness for accreditation surveys, client audits, and regulatory reviews
Oversee URAC and NCQA accreditation activities, including standards interpretation, gap assessments, survey preparation, application management, and response coordination
Lead preparation for external audits, surveys, and delegated oversight reviews
Lead Quality Management and Compliance Committees and provide governance, reporting, and recommendations to leadership
Maintain Quality Management Program documentation, work plans, evaluations, committee records, quality improvement projects, and required reports
Analyze and present quality, compliance, accreditation, complaint, utilization management, and audit data
Oversee complaint investigations, trend analysis, reporting, and corrective actions
Oversee fraud, waste, and abuse reporting activities and documentation
Oversee education tracking, exclusion monitoring, clinician credentialing, licensure verification, and credentialing record maintenance
Provide leadership, coaching, performance management, workload balancing, succession planning, and professional development for Quality team members
Ensure compliance with applicable regulations, accreditation standards, company policies, privacy requirements, and professional standards
Provide exceptional service to internal and external stakeholders and perform other assigned duties

Requirements

What you’ll need

Graduate of an accredited nursing program
Active, unrestricted RN license required
5+ years of utilization management experience in a health plan, UM vendor, or delegated UM organization, including prior authorization
3+ years of quality, audit, compliance, accreditation, or quality management experience, including audit programs, KPI reporting, and corrective action planning
2+ years of progressive leadership experience in a managed care environment with responsibility for staff performance and team outcomes
Demonstrated success developing KPIs, conducting root cause analyses, and driving measurable performance improvement
Working knowledge of URAC and/or NCQA accreditation standards and quality management program requirements
Knowledge of Medicare, Medicaid, and commercial utilization management regulations, including CMS and state utilization review requirements
Experience leading quality, productivity, and performance improvement initiatives
Strong leadership, facilitation, communication, critical thinking, and organizational skills
Ability to thrive in a fast-paced, evolving environment and collaborate effectively across teams
HIPAA-compliant remote location with reliable high-speed internet
Ability to use the telephone, sit, enter data, and view a PC screen for up to 8 hours
Ability to prioritize in a multi-task environment

Benefits

Comp & perks

Performance-based bonuses, incentive pay, or commissions may be available
Medical, dental, and vision insurance
Paid time off (PTO), holidays, and sick leave
401(k) with company match or other retirement plan
Life and AD&D Insurance
Employee Assistance Program
Equal Opportunity Employer
Reasonable accommodations for disabilities and sincerely held religious beliefs