Senior Manager, Quality

Responsibilities

• Own the portfolio of HEDIS, Stars, contractual quality measures, and payer-specific quality campaigns.
• Translate measure specifications and partner requirements into executable workflows, including member identification, tasking, outreach models, roles, timelines, escalation paths, and reporting.
• Develop and maintain job aids, SOPs, training, and enablement for Care Teams and Operations.
• Lead quality initiatives including vaccinations, health risk assessments, in-home wellness assessments, preventive screenings, transition-of-care measures, and gap-closure programs.
• Analyze quality and operational data to identify gaps, validate performance, understand drivers, and recommend interventions.
• Establish performance metrics and operating cadences; monitor and report measure outcomes and operational execution.
• Conduct retrospectives, root-cause analyses, and improvement cycles.
• Partner with Data and Product to define measure logic, dashboards, patient lists, gap reporting, and automated monitoring; validate outputs and troubleshoot discrepancies.
• Lead cross-functional execution across Partnership Operations, Care Teams, Clinical, Data, Product, Marketing, and Care Delivery Operations.
• Build repeatable playbooks, campaign calendars, prioritization processes, and scalable operating infrastructure.
• Apply automation and AI to improve data capture, reporting, and workflow efficiency.
• Surface risks, tradeoffs, and recommendations to senior leaders and contribute to quality governance activities.

Requirements

• 6+ years of experience in healthcare quality, quality operations, population health, value-based care, managed care, health plan operations, consulting, or a related field.
• Meaningful experience with HEDIS, Stars, payer quality measures, or other healthcare quality performance programs.
• Experience translating quality, clinical, or payer requirements into operational workflows for frontline teams.
• Experience prioritizing quality opportunities based on impact, contractual importance, effort, feasibility, and capacity.
• Strong project and program management skills across concurrent campaigns and initiatives.
• Experience independently analyzing healthcare or operational data and translating findings into recommendations.
• Advanced Excel or Google Sheets skills, including large datasets, complex formulas, and data validation.
• Working proficiency with SQL or comparable experience querying and manipulating complex datasets.
• Experience with BI and reporting tools such as Looker, Tableau, Power BI, or equivalent platforms.
• Ability to define reporting requirements, measure logic, and data specifications with Data or Analytics teams.
• Clear written and verbal communication with operational and senior stakeholders.

Nice-to-haves

• Member outreach campaigns, care-team workflows, tasking, job aids, or training for quality measures.
• Claims, eligibility, clinical, care management, or quality-measure datasets.
• Dashboards, automated reporting, or reusable quality analytics workflows.
• NCQA HEDIS specifications or Stars programs.
• Medicare Advantage, Medicaid managed care, or risk adjustment.
• Automation or AI for quality reporting, gap identification, or workflow efficiency.
• CPHQ, Lean Six Sigma, or related quality improvement or analytics training.