Medical Management Quality & Training Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Management Quality & Training Manager based in the United States.

We are seeking an experienced Medical Management Quality & Training Manager to lead quality assurance and professional development initiatives across medical management operations. In this remote leadership role, you will oversee a dedicated Quality and Training team while developing comprehensive onboarding and continuing education programs. You will use audit results, operational metrics, and population trends to identify improvement opportunities and strengthen employee performance and member support. Working closely with medical management leaders and cross-functional partners, you will help standardize processes, improve reporting, and communicate measurable value to clients and stakeholders. You will also drive the evolution of training, quality monitoring, and reporting practices through technology and continuous improvement. This position offers an opportunity to combine people leadership, analytical expertise, and healthcare operations knowledge to make a meaningful organizational impact.

Accountabilities

As the Manager, Medical Management Quality & Training, you will lead the quality and learning strategy supporting medical management teams, ensuring employees have the skills, resources, and guidance needed to deliver effective member support. Your key responsibilities will include:

• Lead, coach, and develop the Quality and Training team by establishing performance expectations, providing regular feedback, supporting individual development, and allocating resources effectively.

• Design, deliver, and maintain structured onboarding and continuing education programs, including training modules, assessments, knowledge checks, practical exercises, reference materials, and refresher courses.

• Collaborate with department leaders and subject matter experts to identify learning needs, standardize onboarding practices, coordinate cross-functional training, and strengthen employee readiness.

• Oversee quality auditing standards, calibration practices, scorecards, and review processes to ensure consistent evaluation and constructive feedback.

• Guide auditors in translating recurring quality findings into targeted education, performance improvement initiatives, and better member support outcomes.

• Analyze audit results, quality metrics, employee feedback, client reports, case volumes, utilization, claims, and population trends to identify systemic gaps and recommend improvements.

• Develop targeted recommendations involving training, workflows, outreach, referrals, and operational processes based on data-driven insights.

• Evaluate the effectiveness of quality and training initiatives through competency reviews, assessments, audit outcomes, trend analysis, and stakeholder feedback.

• Ensure impact narratives, value stories, and client reports accurately demonstrate the work performed for members and the value delivered to clients.

• Partner with Medical Management leadership, Client Management, and Growth Marketing to align priorities with client needs and develop approved external materials, case studies, and visual content.

• Present and advocate for recommendations by clearly explaining their rationale, expected impact, resource requirements, and implementation steps.

• Balance people leadership, training delivery, quality oversight, reporting, and cross-functional projects while maintaining operational effectiveness.

• Support continuous improvements in technology, automation, learning platforms, reporting systems, and quality-monitoring tools.

• Ensure practices remain aligned with internal policies, client requirements, vendor guidelines, and applicable compliance expectations.

• Perform additional responsibilities as assigned.

Requirements

The ideal candidate combines healthcare operations experience with strong people management, analytical capabilities, and a proven background in quality assurance and employee development. You should be comfortable translating complex data and operational findings into practical recommendations while collaborating with stakeholders across multiple departments. Key qualifications include:

• Bachelor's degree or equivalent professional experience.

• At least 5 years of experience in case management, medical management, quality assurance, training, healthcare operations, or a related field.

• Experience within a third-party administrator (TPA), insurance carrier, or healthcare organization is preferred.

• At least 3 years of supervisory or people-management experience, including coaching and developing employees with different professional backgrounds and levels of experience.

• Demonstrated experience conducting or overseeing quality audits, providing constructive feedback, and translating audit findings or quality scores into measurable performance improvements.

• Proven ability to design and deliver structured onboarding and continuing education programs, including training modules, assessments, and practical learning activities beyond basic job aids or workflow documentation.

• Strong analytical and strategic-thinking skills, with the ability to interpret quality metrics, large datasets, client reports, claims and utilization information, and population trends.

• Ability to identify recurring issues, recognize operational improvement opportunities, and develop clear, actionable recommendations.

• Excellent coaching, facilitation, presentation, and communication skills, including the ability to explain complex healthcare and operational concepts to diverse audiences.

• Confidence advocating for recommendations and presenting ideas and findings to leadership.

• Strong collaboration skills and the ability to work effectively with Medical Management, Client Management, Growth Marketing, and other internal teams.

• Proven ability to manage competing priorities across people leadership, quality assurance, training, reporting, and project delivery.

• Working knowledge of adult learning principles, instructional design, quality assurance practices, self-funded health plans, and third-party administration preferred.

• Familiarity with remote or blended learning tools and the ability to adapt to evolving learning technologies.

• Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook, with the ability to learn reporting, auditing, workflow, and learning management systems.

• Strong accountability, decision-making, execution management, customer focus, communication, influence, and time-management skills.

• Ability to work remotely in a standard desk-based environment, with extended periods of sitting and computer use.

• Reliable cable broadband or fiber-optic internet connection with minimum speeds of 100 Mbps download and 25 Mbps upload.

Benefits

• Fully remote work environment with the flexibility and comfort of working from home.

• Competitive total rewards and benefits package.

• Medical, dental, and vision insurance.

• Life and disability insurance.

• Generous paid time off.

• Tuition reimbursement to support continued learning and professional development.

• Employee Assistance Program (EAP).

• Technology stipend to support remote work.

• Remote-work support designed to help employees stay connected and productive.