The posting
This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Health Plan Quality Program Management & Performance Manager based in United States.
The Health Plan Quality Program Management & Performance Manager will lead quality improvement initiatives and ensure health plan programs comply with state, federal, and industry regulatory requirements. This role focuses on quality management, performance monitoring, and compliance with standards established by NCQA and HEDIS. You will oversee complex quality deliverables, coordinate audits and accreditation activities, and translate regulatory requirements into effective program plans. Working closely with quality leadership and cross-functional teams, you will monitor performance, address compliance gaps, and identify opportunities for continuous improvement. The position combines healthcare quality expertise, analytical thinking, project management, and stakeholder collaboration to strengthen program outcomes. This is a remote opportunity for a Michigan-based professional with experience in Medicaid, managed care, or health plan quality improvement.
Accountabilities
- Lead quality program management activities to ensure compliance with state and federal regulations and National Committee for Quality Assurance (NCQA) requirements.
- Serve as a subject matter expert for the quality management team, providing guidance and support for quality-related projects, programs, and initiatives.
- Plan, implement, and maintain quality improvement activities that meet regulatory and reporting requirements.
- Prepare and finalize documentation for quality program management committees and other formal meetings, including discussions, participant contributions, follow-up actions, and next steps.
- Oversee complex quality management activities, including preparation for quality improvement reports, audits, accreditation surveys, and other required state, federal, and NCQA activities.
- Monitor key quality deliverables to ensure they are completed accurately and on schedule, and present findings to departmental leaders, stakeholders, and formal committees.
- Prepare narrative reports, interpret regulatory specifications, explain program outcomes, and document findings in collaboration with quality management colleagues.
- Maintain quality program management plans that document applicable state, federal, and NCQA requirements and associated activities.
- Collaborate with state and national quality leaders to update policy and procedure addendums and document state-specific requirements.
- Create, manage, and compile documentation supporting essential quality improvement functions.
- Lead quality improvement meetings and cross-functional discussions to ensure programs meet regulatory and performance standards.
- Evaluate program activities and results to identify improvement opportunities and recommend corrective actions.
- Partner with quality leadership to investigate escalations, resolve issues, and remediate performance or compliance gaps.
- Provide training, guidance, and ongoing support to new and existing quality management team members.
- Travel as required to support health plan and state-specific needs, including approximately 0–50% same-day travel and 0–20% overnight travel.
- At least 6 years of healthcare experience, including a minimum of 4 years in health plan quality improvement, or an equivalent combination of relevant education and experience.
- Strong knowledge of HEDIS (Healthcare Effectiveness Data and Information Set) and NCQA quality standards and requirements.
- Experience managing quality improvement compliance deliverables related to state and federal regulators.
- Familiarity with Michigan Medicaid, managed care, or other government-sponsored healthcare programs.
- Strong business writing skills, including the ability to prepare detailed reports, committee documentation, and regulatory deliverables.
- Proficiency in data analysis, manipulation, interpretation, and reporting.
- Strong critical-thinking, analytical, and problem-solving skills, with excellent attention to detail and organizational ability.
- Demonstrated project management experience, including coordinating multiple high-priority deliverables and meeting strict deadlines.
- Ability to implement process improvements, drive change, and work effectively across departments.
- Excellent written and verbal communication skills, including the ability to explain complex regulatory requirements and present findings to stakeholders.
- Ability to work independently in a fast-paced, deadline-driven environment while managing competing priorities.
- Proficiency in Microsoft Office applications, particularly Excel, and the ability to learn new systems and software.
- Clinical licensure or certification may be required when mandated by applicable state contracts, regulations, business operating models, or licensing boards.
- Previous management or leadership experience.
- Experience with HEDIS data collection and reporting.
- Experience improving Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance.
- State-level quality improvement experience.
- Experience working with government-sponsored programs, including Medicaid, Medicare, or Marketplace plans.
- Professional certification such as Certified Professional in Health Quality (CPHQ) or Certified HEDIS Compliance Auditor (CHCA).
- Registered Nurse (RN) qualification; any applicable license must be active and unrestricted in the state of practice.
- Annual salary range: $66,456–$129,590, with actual compensation depending on geographic location, work experience, education, and skill level.
- Competitive compensation package: Compensation is based on relevant qualifications and experience.
- Remote work arrangement: The position is remote, but candidates must reside in Michigan.
- Full-time employment: A full-time role focused on healthcare quality management and performance improvement.
- Additional benefits: A competitive benefits package is offered; specific details regarding healthcare coverage, retirement plans, paid time off, and other benefits were not provided in the job description.
- Professional development: Opportunity to strengthen expertise in healthcare quality, regulatory compliance, HEDIS, NCQA accreditation, and program leadership.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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