Principal, HEDIS Quality Programs

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of Waymark’s portfolio of HEDIS contractual quality measures and the strategic roadmap across partnerships.

• Convert measure specifications and partner requirements into actionable programs, workflows, and a scalable operational framework.

• Scope and directly oversee vendor partners for last-mile gap closure, which includes home lab visits and distribution of at-home diagnostic kits.

• Conduct retrospectives, root cause analyses, and structured improvement cycles to expedite gap closure.

• Collaborate with Care Operations and Learning and Development teams to create job aids, standard operating procedures (SOPs), training materials, and enablement resources.

• Manage supplemental data submissions and reconciliation across payer partners.

• Work with Analytics to establish measure logic, dashboards, patient lists, gap reporting, and automated monitoring; validate outputs and resolve discrepancies.

• Serve as a subject matter expert on HEDIS best practices, automation, and AI innovations to advise Clinical Product Development.

• Provide guidance to Business Development regarding HEDIS metrics and targets during contract negotiations.

• Stay informed on industry trends and best practices in quality and clinical management, integrating insights into operations and product design.

• Report directly to the Vice President of Care Operations.

⛳️ Requirements

• A minimum of 7 years of experience in healthcare quality, quality operations, population health, value-based care, managed care, or a related field.

• At least 5 years of experience with NCQA HEDIS quality measures and performance programs, including the translation of requirements into implementable, scalable programs and operational workflows.

• Proficiency with business intelligence and reporting tools such as Looker, Tableau, Power BI, or similar platforms.

• Strong program and project management capabilities with a proven ability to lead complex, cross-functional initiatives and manage competing priorities in a fast-paced setting.

• Proven ability to independently drive program execution with a proactive approach.

• Demonstrated history of managing operational vendors or clinical partners to deliver home-based services, diagnostic programs, or field campaigns.

• Exceptional written and verbal communication abilities, including presentation skills for engaging with executive leadership, training frontline staff, and building solid partnerships with cross-functional teams and external stakeholders.

• Proven ability to identify and manage risks associated with quality programs, develop mitigation strategies, and promote a culture of continuous improvement.

• Experience in designing member outreach campaigns, care-team workflows, tasking, job aids, or training in support of quality measures.

• Capability to manage large data sets, analyze data, identify gaps, and develop reporting for performance management.

• Must be adept at working in a matrix environment.

• Bachelor’s degree is required.

• Employment is contingent upon successful completion of a background check.

• Experience in Medicaid managed care is preferred.

• Lean Six Sigma or a related quality improvement certification is preferred.

• A graduate or advanced degree (MPH, MHA, MBA) is preferred.

🏝️ Benefits

• Stock Options: Opportunity to invest in the company’s growth.

• Work-from-Home Stipend: A dedicated stipend for your first year to help set up your home office.

• Incentive Program: Receive additional compensation through performance-based incentives that align with organizational goals and enhance patient outcomes.

• Medical, Vision, and Dental Coverage: Comprehensive plans to keep you and your family healthy.

• Life Insurance: Basic life insurance to provide peace of mind.

• Paid Time Off: 20 vacation days accrued over the year, plus 11 paid holidays.

• Parental Leave: 16 weeks of paid leave for birthing parents after six months of employment, and 8 weeks of bonding leave for non-birthing parents.

• Retirement Savings: Access to a 401(k) plan with a company contribution, subject to a vesting schedule.

• Commuter Benefits: Convenient options to support your commute needs.

• Professional Development Stipend: A dedicated stipend to support professional development and growth.