Program Manager II, Quality Reporting – Data Governance

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

📋 Description

• Act as a subject matter expert and strategic collaborator for quality reporting, data governance, quality assurance, quality control, and regulatory reporting.

• Lead processes for quality assurance and quality control related to HEDIS, PMRR, CAHPS, QHP, HOS, and other quality measurement initiatives.

• Create, implement, and monitor quality controls to ensure data accuracy, regulatory compliance, audit preparedness, and operational consistency.

• Collaborate with internal teams, third-party auditors, and vendors on compliance, audit preparedness, and program execution.

• Manage the resolution of audit findings, quality issues, and compliance risks.

• Enhance quality assurance and quality control frameworks, incorporating validation methodologies, quality reviews, audit protocols, issue tracking, and corrective action plans.

• Assess control effectiveness and suggest improvements for risk reduction and performance enhancement.

• Spearhead validation activities to evaluate the accuracy, completeness, consistency, and reliability of regulatory reporting and performance data.

• Perform root-cause analysis on quality defects, reporting discrepancies, and audit findings.

• Propose corrective and preventive actions to strengthen data governance processes.

• Organize mock audits, control testing, documentation reviews, quality monitoring, and remediation planning.

• Ensure compliance with NCQA, CMS, state, and external audit requirements.

• Oversee vendor performance, adherence to contracts, and metrics for quality initiatives.

• Facilitate documentation for quality governance, reporting controls, policy compliance, and communication of risks and recommendations to leadership.

• Create and maintain project plans, milestones, tasks, and completion timelines.

• Establish SMART goals, allocate resources, monitor timelines, eliminate obstacles, escalate risks, and propose mitigation strategies.

• Stay updated on industry trends, regulatory changes, and best practices to identify strategic opportunities.

• Maintain communication with stakeholders and provide updates on project status, issues, and recovery plans.

• Cultivate professional relationships with key partners and keep stakeholders engaged throughout the project lifecycle.

⛳️ Requirements

• Bachelor's degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or a related field, or an equivalent combination of education and/or highly relevant experience.

• A minimum of 3 years' experience in program management, preferably in areas related to HEDIS, CMS Star, Value Based Payment Programs, Risk Adjustment, or general healthcare.

• PMP, Agile Professional, or another formal project management certification is preferred.

• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint), with advanced Excel skills.

• Experience using SharePoint, Confluence, JIRA, or Smartsheet for project management, workflow tracking, documentation, issue management, operational planning, and cross-functional collaboration.

• Strongly preferred experience in program development, product development, process improvement, and evaluation.

• Working knowledge of SQL and/or Snowflake data environments, including data querying and validation, supporting reporting activities, investigating data quality issues, and collaborating with analytics, engineering, and technical teams is preferred.

• Experience with Community Health Centers, Federally Qualified Health Centers, or other healthcare systems focused on individuals with low income and/or barriers to equitable healthcare is preferred.

• Understanding of Medicaid, Medicare, and/or Exchange principles and practices, including CMS, NCQA, PQA, Milliman, and/or Acumen, with a focus on quality improvement.

• Strong analytical skills with the capability to interpret data, identify trends, summarize information, and communicate findings clearly.

• Proficient in vendor management, objective targeting, and monitoring service level agreements.

• Knowledge and experience in applying change management principles, practices, and methodologies.

• Ability to adapt to dynamic work environments and manage multiple tasks and projects simultaneously.

• Capability to work both independently and collaboratively.

• Strong attention to detail and ability to meet established deadlines.

• Excellent organizational skills.

• Strong presentation skills for complex data, reports, and training sessions.

• Must successfully pass a criminal background check.

• Must not be excluded or sanctioned from federal or state healthcare programs.

🏝️ Benefits

• 10% annual incentive target based on company, department, and individual performance goals.

• Medical, Prescription, Dental, and Vision coverage.

• Access to a Telehealth app.

• Flexible Spending Accounts.

• Health Savings Accounts.

• Basic Life AD&D insurance.

• Short- and Long-Term Disability coverage.

• Voluntary Life, Critical Care, and Long-Term Care Insurance options.

• 401(k) Retirement plan with a generous employer match.

• Employee Assistance Program and Mental Fitness app.

• Financial Coaching services.

• Identity Theft Protection.

• PTO accrual starting at 17 days per year.

• 40 hours of Community Service volunteer time.

• 10 standard holidays.

• 2 floating holidays.

• Compassionate leave.

• Jury duty leave.

• Reasonable accommodations for disabilities.