Manager, National Risk & Quality Solutions

Accountabilities Lead and manage the Quality Systems team, establishing expectations, monitoring performance, coaching employees, and supporting professional development.

Oversee quality-system performance initiatives and ensure team activities remain aligned with quality strategies, regulatory requirements, and organizational priorities.

Support annual quality-data submission activities, including NCQA and state regulatory submissions.

Design and implement data-focused strategies that improve the completeness, accuracy, and reliability of data ingestion, including supplemental and Health Information Exchange (HIE) data.

Partner with quality leaders and health plans to develop meaningful reporting and analytics covering quality-rate trends and forecasts, provider performance, CAHPS and survey analytics, and health equity.

Oversee quality project plans, schedules, resource allocation, deliverables, and regulatory compliance.

Identify project risks and barriers, develop mitigation strategies, and ensure complex issues are appropriately prioritized, escalated, and resolved.

Analyze quality data to identify issues, determine root causes, and develop actionable recommendations and solutions across business functions.

Conduct quality reviews and audits, address discrepancies, and maintain consistently high standards of performance.

Develop data-quality strategies and solutions designed to close quality-of-care gaps.

Communicate portfolio performance, risks, dependencies, and recommended remediation strategies to leadership and key stakeholders.

Foster a collaborative, accountable, and high-performing team while hiring, training, developing, and managing employees.

Requirements

At least 7 years of program or project management experience in healthcare quality , including experience supporting HEDIS activities, targeting, and reporting, or an equivalent combination of education and relevant experience.

At least 1 year of management or leadership experience .

Comprehensive understanding of managed healthcare value drivers, quality programs, and the broader healthcare industry.

Extensive knowledge of healthcare claims and coding elements, including CPT, CPT Category II, LOINC, SNOMED, HCPCS, NDC, CVX, NPI, and TIN.

Experience running queries using Microsoft Azure and/or SQL Server, with strong data-analysis, manipulation, interpretation, and reporting capabilities.

Strong quantitative aptitude, critical-thinking, analytical, problem-solving, organizational, and decision-making skills.

Ability to evaluate cross-functional impacts, weigh costs and benefits for upstream and downstream stakeholders, and develop solutions that create value across multiple business areas.

Intellectual agility and the ability to simplify and communicate complex concepts clearly to technical and non-technical audiences.

Proven ability to collaborate with multiple levels of leadership and operate effectively within complex, highly matrixed organizations.

Strong verbal, written, and presentation communication skills.

Proficiency with Microsoft Office, particularly Excel, and the ability to quickly learn and navigate new software platforms.

Experience supporting Medicaid, Medicare, and/or Marketplace programs within a managed-care environment is preferred.

Advanced knowledge of NCQA, HEDIS, CMS, and state-specific regulatory submission requirements is a plus.

Advanced Microsoft Azure Databricks and SQL expertise is preferred.

PMP certification, Six Sigma Green Belt or Black Belt certification, or comparable coursework is advantageous.

Benefits

Full-time, fully remote position within the United States.

Annual salary range of $79,607.91–$172,483.80 , with actual compensation determined by factors such as location, experience, education, and skills.

Competitive benefits and compensation package.

Opportunity to lead a specialized quality team and influence enterprise-wide healthcare quality initiatives.

Exposure to healthcare analytics, regulatory reporting, quality improvement, and data strategy at scale.

Opportunities for professional development, team leadership, and cross-functional collaboration.

Equal-opportunity workplace with reasonable accommodations available to qualified applicants.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

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