Manager, Performance Quality Improvement

This is a fully remote position, open to applicants in Iowa, +1 more state.

📋 Description

• Provide strategic oversight for HEDIS Operations and Quality Improvement initiatives.

• Drive excellence in NCQA and HEDIS performance throughout the organization.

• Lead the planning and execution of hybrid seasons.

• Ensure readiness for audits and compliance with regulatory reporting.

• Oversee vendor management and operations related to chart retrieval.

• Implement strategies driven by data to enhance quality measure performance and health outcomes.

• Analyze data to formulate intervention strategies aimed at improving outcomes.

• Develop and execute performance improvement projects.

• Create, prepare, and present reports on quality programs and issues to both internal and external stakeholders.

• Provide data analysis and support for Quality Management projects (e.g., outcome studies, Quality Improvement projects).

• Coordinate the ongoing data management for HEDIS and Quality Improvement project management databases.

• Evaluate sources for alternative data capture and assess ongoing methodologies and results.

• Oversee the medical record management process for HEDIS reporting.

• Develop tracking tools and programs to assist HEDIS staff in driving improvements for HEDIS and 5 Star projects.

⛳️ Requirements

• Bachelor's degree in healthcare, business, or a related field, or equivalent experience.

• At least 4 years of experience in quality improvement data analysis and outcome analysis within healthcare.

• Preferred experience in managed care with knowledge of HEDIS and NCQA standards.

• Proven experience leading HEDIS Operations in a health plan, managed care, or healthcare quality environment.

• Strong understanding of NCQA accreditation standards, HEDIS measures, hybrid methodology, and audit requirements.

• Demonstrated success in managing hybrid reviews, chart retrieval operations, and vendor relationships.

• Experience with regulatory reporting, quality improvement programs, and performance measurement initiatives.

• Proven ability to lead large-scale operational projects and collaborate effectively across clinical, quality, analytics, and operations teams.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work approach, including remote, hybrid, field, or office work schedules.