Quality Management Director (Remote in California)

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

The Quality Management Director serves a critical function providing review and monitoring of services provided by Gainwell on the Medi-Cal account. The position is responsible for the quality management program and is the primary point of communication with the client. The position will use deep healthcare claims processing and Medi-Cal policy knowledge to ensure compliance. The position provides day-to-day directions to a small team in a matrixed organization structure. Your role in our mission

• As a member of the account management team will work to set the strategy and vision for the account’s Quality Management activities including Quality Assurance, Quality Control and reporting.
• Responsible for communication and coordination across all Business Services across the account’s operations, as well as communication with the client.
• Plays a critical role in providing data, direction on operational procedures, and procedure manuals with a focus on flow and inclusion of quality processes and measurement.
• Provides structure, methodologies and direction for root cause analysis, corrective actions and ongoing process improvements.
• Under minimal supervision, using independent professional judgement, respond to inquiries from clients, and internal stakeholders with professionalism and accuracy. Manage all account quality management activities as well as provide leadership and support to the quality management team.

What We're Looking For

• Must possess a Bachelor’s degree and a minimum of four (4) years of quality management (QM) experience (additional relevant management experience may substitute for the degree on a year-for-year basis).
• Quality Management experience shall be specific to a large-scale healthcare payer operation with an emphasis on customer and service delivery.
• Two (2) years of Medicaid Management Information System (MMIS) or government, or private sector healthcare payer experience.
• Strong analytical, communication, and organizational skills with the ability to manage multiple priorities; including project management capabilities, conducting root-cause analysis and process improvement.
• Excellent leadership and management skills to provide direction to and engage with both local and leveraged quality team members.

What You Should Expect In This Role

• Must be a resident of the state of California.
• Willingness to travel to the office as requested. Employees working-from-home may be required to report to the office, at times, to support meetings, special quality-focused requests or other business needs. The office is in West Sacramento.
• This is a full-time permanent regular salaried (W-2) employee position.
• Monday through Friday work schedule.
• Health (medical, dental, vision) benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer for work use. For all hybrid and remote positions employees' Broadband Internet connections should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• This position will remain posted until it is filled or January 31, 2026, which ever comes first. Applying does not guarantee an interview.

The pay range for this position is $90,700.00 - $129,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. Apply tot his job Apply To this Job