National Quality Performance Manager- HEDIS / SQL
Accountabilities Collaborate with health plan quality leaders to develop and manage quality data collection strategies, analytics, and reporting covering HEDIS performance, quality-rate trending and forecasting, provider performance, CAHPS and survey analytics, health equity, SDOH, and external vendor activities.
Monitor quality-related programs and projects from initiation through successful delivery, ensuring milestones, resources, deliverables, and timelines remain aligned with strategic objectives.
Oversee quality data ingestion and validation activities, identify data issues, document findings, and improve the completeness and accuracy of EHR, HIE, and supplemental data.
Analyze quality performance data to identify trends, risks, care gaps, and opportunities for measurable improvement.
Support compliance with quality-related regulatory and audit requirements by managing deliverable roadmaps and timelines and implementing solutions that strengthen HEDIS audit readiness and performance.
Partner with cross-functional teams to maintain data quality across sequential transformations and identify opportunities to close quality-of-care gaps.
Create, review, and maintain quality program documentation, including project plans, reports, records, analyses, and supporting materials.
Provide clear and proactive status reporting to stakeholders, communicating progress, risks, issues, dependencies, and recommended actions.
Build effective relationships with internal and external stakeholders, establish trust, understand customer expectations, and ensure quality initiatives meet business and operational requirements.
Support enterprise-wide quality performance improvement initiatives through data-driven insights and coordinated execution.
Requirements
At least 3 years of program or project management experience within healthcare quality, or an equivalent combination of relevant education and professional experience.
Healthcare industry experience or demonstrated functional knowledge of healthcare quality programs.
Strong knowledge or practical experience related to HEDIS, NCQA, CAHPS, CMS, and state-specific quality or regulatory submission requirements is preferred.
Experience with SQL or the ability to run queries using Microsoft Azure or SQL Server is preferred.
Strong proficiency in data analysis, manipulation, interpretation, reporting, and quantitative problem-solving.
Ability to translate complex technical or quality concepts into clear, actionable information for diverse stakeholders.
Strong critical-thinking, analytical, problem-solving, organizational, and attention-to-detail skills.
Knowledge of healthcare data and coding elements such as CPT, CPT II, LOINC, SNOMED, HCPCS, NDC, CVX, NPI, and TIN is preferred.
Experience working in a highly matrixed organization, preferably within managed care environments supporting Medicaid, Medicare, and/or Marketplace programs.
Strong verbal, written, presentation, and stakeholder-management skills.
Proficiency with Microsoft Office, including Excel, and the ability to quickly learn and navigate new technology and software platforms.
Ability to collaborate effectively across departments, manage multiple priorities, and maintain progress across complex initiatives.
PMP certification is preferred.
Six Sigma Green Belt, Black Belt, or comparable coursework is preferred.
Benefits
Annual salary range of $59,810.60–$129,589.63 , with actual compensation varying based on geographic location, professional experience, education, and skill level.
Full-time, fully remote position within the United States.
Opportunity to work on national healthcare quality performance initiatives involving HEDIS, CAHPS, SQL, analytics, and regulatory quality programs.
Cross-functional exposure to health plan quality, data, analytics, regulatory, and operational teams.
Opportunity to contribute directly to quality improvement, care-gap closure, data accuracy, and healthcare outcomes.
Competitive compensation and benefits package.
Equal employment opportunity workplace.
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