Health Plan Quality Program Mgmt & Performance Manager

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.

Requirements:

• 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.

Preferred qualifications:

• 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.

Benefits:

• 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.