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Quality Manager

Optum
Optum
2+ years
$71,200 to $127,200
10 July 31, 2025
Job Description
Job Type: Full Time Education: B.Sc./M.Sc./B.Pharm/M.Pharm/Life science Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Quality Manager – Colonial Healthcare
Location: Sumter, SC
Job Category: Medical & Clinical Operations
Requisition Number: 2301661
Estimated Salary: $71,200 – $127,200 per year


About the Role:
Colonial Healthcare, a part of UnitedHealth Group’s OptumCare, is seeking a Quality Manager to lead and oversee quality improvement programs, care coordination strategies, and value-based care performance for its expanding network across South Carolina. Reporting to the VP of Operations, the Quality Manager will be instrumental in maintaining the Patient-Centered Medical Home (PCMH) model and driving improvements across HEDIS, CAHPS, Stars, ACO, and MIPS metrics.


Key Responsibilities:

  • Manage and oversee performance on HEDIS, Stars, PCMH, CAHPS, ACO, and MIPS metrics across the organization.

  • Lead patient outreach workflows, ensuring timely engagement for preventive services and gap closures.

  • Oversee compliance and performance across full-risk and Pay-for-Performance (P4P) programs across Medicare, Medicaid, and Commercial lines.

  • Develop workflows for data collection, audits, reporting, and clinical outcomes related to PCMH.

  • Ensure continuity of care post-hospitalization or emergency department visits.

  • Coordinate with IT and Analytics to automate supplemental data submissions to payers.

  • Identify quality trends and develop strategies for continuous improvement.

  • Supervise a dedicated team focused on healthcare quality measures.

  • Coordinate and complete medical records requests while maintaining HIPAA and regulatory compliance.


Required Qualifications:

  • High school diploma or equivalent

  • Active certification or licensure in a clinical field (CMA, LPN, Radiologic Technologist, etc.)

  • 5+ years of management or supervisory experience

  • Strong knowledge of quality-based care metrics including HEDIS

  • Familiarity with chronic disease management and population health strategies

  • Experience with Electronic Health Records (EHRs) and disease registries

  • Excellent leadership, communication, and organizational skills

  • Willingness to travel up to 50% to local clinics (must have Driver’s License and reliable transportation)


Preferred Qualifications:

  • Bachelor’s degree in Nursing, Public Health, Healthcare Administration, or related field

  • 2+ years of management experience within a group medical practice

  • Proven success in building and retaining high-performing teams

  • Strong understanding of performance-driven incentive programs


Why Join Us?
At Colonial Healthcare, your role goes beyond managing metrics—you’ll drive meaningful, patient-centered quality improvements that support healthier lives. Be part of a forward-thinking team focused on transforming care delivery and optimizing outcomes through strategic, data-driven leadership.


Benefits Include:

  • Comprehensive medical, dental, and vision insurance

  • Incentive and recognition programs

  • 401(k) plan with employer contributions

  • Employee stock purchase plans

  • Paid time off and continuous development support