Quality Program Manager

Job Title: Quality Program Manager 

Location: Remote (must have knowledge of New York market)

Type: Direct Hire

Overview:
Oversee and actively participate in quality improvement projects that support the organization’s mission of effectively managing members and improving health outcomes. Serve as a liaison between Quality Management and internal/external partners for quality initiatives. Act as a subject matter expert in quality improvement and reporting.

Key Responsibilities:

• Plan, implement, and oversee quality improvement projects and action plans (HEDIS, CAHPS, and HOS) across Medicare, Medicaid, QHP, and Commercial product lines.
• Support the execution of centrally developed data-driven strategic plans.
• Lead or assist in cross-functional collaboration on HEDIS, CAHPS, HOS, Pharmacy, and Enterprise metrics.
• Serve as the point of contact for quality vendors; develop and distribute target lists; monitor vendor performance against SLAs; maintain communication between vendors and internal teams.
• Manage ongoing quality programs including Member Rewards & Incentives, Provider Quality Incentives, and health disparity initiatives.
• Provide subject matter expertise on all quality metrics to internal stakeholders.
• Support compliance with NCQA, CMS, HEDIS, CAHPS, HOS, and other applicable regulatory requirements.
• Collaborate with data teams to analyze and report on quality initiatives to inform future strategies.
• Develop and manage annual performance improvement projects; analyze data and produce final reports.
• Create methodologies for evaluating quality program outcomes (e.g., ROI, proof points).

Qualifications:

• Bachelor’s Degree required; Master’s Degree strongly preferred.
• Knowledge of New York Market.
• Project Management or Vendor Management certification preferred.
• 5–8 years of relevant professional experience required.
• 3–5 years of quality or program management experience in a managed care setting required.
• Additional years of experience or certifications may substitute for formal education.
• Proven experience in developing and assessing quality metrics and analytics.
• Strong understanding of contractual or compliance-related Service Level Agreements (SLAs).
• Ability to manage multiple tasks/projects with competing priorities and deadlines.
• In-depth knowledge of HEDIS/QARR, CAHPS, CMS Star Ratings, and accreditation processes.
• Proficient in Microsoft Office (Word, PowerPoint, Excel, Outlook); working knowledge of Microsoft Access preferred.
• Excellent written, verbal, interpersonal, and presentation communication skills.

 We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws