About this role
About the Role The Manager, Quality Improvement is responsible for leading quality improvement initiatives that support performance across HEDIS, Medicare Stars, and other quality programs. This role collaborates with providers, health plans, IPA partners, and cross-functional teams to improve quality outcomes, close care gaps, enhance provider performance, and support organizational quality goals. The Manager provides operational leadership for assigned quality programs, regional quality operations, provider engagement activities, regulatory compliance, and quality performance initiatives while developing high-performing teams and fostering a culture of accountability and continuous improvement. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team Quality Performance & Program Management Lead day-to-day operations for assigned quality programs, regions, projects, and lines of business, ensuring achievement of key quality measures and performance goals. Monitor health plan quality metrics and ratings, identify performance gaps, and implement improvement initiatives to drive measurable outcomes. Partner with regional and cross-functional stakeholders to develop and execute care gap closure and quality improvement strategies. Analyze performance trends and communicate findings, risks, barriers, and recommendations to leadership, providers, and health plan partners. Oversee quality data workflows and reporting processes to ensure accurate, complete, and timely submission of required data. Provider & Health Plan Engagement Lead meetings with health plans, IPA partners, providers, and operational stakeholders to review performance, address opportunities, and advance quality improvement initiatives. Drive provider engagement and education efforts supporting HEDIS, Medicare Stars, NCQA measures, value-based care objectives, and compliant care gap closure activities. Serve as a subject matter expert on quality measures, NCQA standards, and quality improvement best practices. Present performance updates, recommendations, and best practices while maintaining strong relationships with health plans and external partners. Leadership & Team Development Manage, mentor, and develop a team responsible for provider engagement, outreach, and quality improvement activities. Lead recruitment, onboarding, performance management, coaching, and professional development efforts to build and retain a high-performing team. Foster a culture of collaboration, accountability, continuous improvement, and service excellence in partnership with Human Resources and department leadership. Compliance & Operational Excellence Support payer audits, regulatory reviews, and delegated oversight activities while ensuring compliance with contractual, regulatory, and NCQA requirements. Identify operational risks and barriers, implement corrective actions, and ensure consistent execution of quality initiatives across assigned markets and provider networks. Participate in regional meetings and support organizational priorities, special projects, and other duties as assigned.