• Leading the daily operations of the Potential Quality Incident/Provider Preventable Condition and clinical reporting nurse teams. • Ensure the complete review of Quality-of-Care cases, adherence to standard work, reporting accuracy, and compliance with IEHP policies, Local, State, and Federal laws, and regulations. • The planning and implementation of any quality audit initiatives, programs, and processes identified by IEHP’s Quality System. • Responsible for managing direct reports to ensure effective resource management and prioritization of work in support of meeting Quality and Organizational goals and priorities. • Responsible for the development, management, implementation, and evaluation of all areas of responsibility including, but not limited to, Potential Quality Incidents (PQI)/Provider Preventable Conditions (PPC) processes, Quality Reviews, and clinical audits of IEHP Providers to ensure clinically appropriate billing. • Provide oversight and management of the PQI and PPC processes and staff to comply with IEHP policies, Local, State, and Federal standards, and regulations. • Collaborate with appropriate internal and external departments, team members, and entities to achieve organizational quality initiatives, as assigned. • Responsible for the development, maintenance, implementation, and adherence to departmental policies and procedures, standard operating procedures, and job aides. • Participate in Quality Management activities and projects to ensure interventions meet project goals. • Lead, prepare, and coordinate appropriate Provider Quality Review department related internal meetings. • Represent IEHP in external meeting related to key areas of responsibility as appropriate. • Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.