Healthcare Performance & Improvement Lead

Accountabilities Lead quality assurance and performance oversight activities to ensure contractual requirements, quality standards, and operational objectives are consistently achieved.

Design, coordinate, and execute compliance assessments, operational reviews, and performance evaluations across healthcare operations.

Monitor administrative and clinical performance trends, identifying opportunities to improve member experience, continuity of care, and operational efficiency.

Develop actionable recommendations and lead continuous improvement initiatives aligned with strategic healthcare and program objectives.

Respond to performance reviews, audit requests, and ad hoc reporting requirements by delivering accurate, timely, and well-documented information.

Maintain expertise in quality measurement methodologies, acceptable quality levels (AQLs), reporting standards, and operational monitoring processes.

Collaborate with cross-functional teams, including claims, enrollment, provider network, care coordination, and clinical operations, to implement quality improvements.

Analyze operational data using reporting and business intelligence tools to track key performance indicators, identify trends, and measure improvement outcomes.

Promote best practices, strengthen compliance readiness, and support a culture of operational excellence across healthcare functions.

Requirements

Bachelor's degree and at least 3 years of experience in healthcare quality management, performance improvement, compliance, or healthcare operations.

Experience supporting federal healthcare programs, health plans, third-party administrators, or other highly regulated healthcare environments.

Strong understanding of healthcare operations, including claims processing, enrollment, provider networks, care coordination, certification, and quality oversight.

Proven experience leading compliance assessments, operational reviews, performance monitoring, and continuous improvement initiatives.

Experience identifying process improvement opportunities and collaborating with business stakeholders to implement operational enhancements.

Proficiency with data analysis and reporting tools, including Microsoft Excel and Power BI.

Excellent analytical, organizational, project management, and problem-solving abilities.

Strong written and verbal communication skills with experience preparing executive reports and supporting audits or regulatory reviews.

Experience supporting CDC, CMS, or other federal healthcare programs, as well as knowledge of public health or government-sponsored healthcare initiatives, is considered an advantage.

Benefits

Competitive annual salary ranging from $112,840 to $115,000 , based on experience, location, and contractual requirements.

Fully remote position within the United States with a flexible work schedule.

Comprehensive medical, dental, and vision insurance options.

Health Savings Account (HSA) eligible healthcare plans.

401(k) retirement plan with employer matching contributions.

Generous paid time off, including vacation, sick leave, personal leave, company holidays, parental leave, military leave, bereavement leave, and jury duty leave.

Short-term and long-term disability coverage, life insurance, accident insurance, and critical illness protection.

Professional development opportunities, including paid certifications, continuing education, and career mobility programs.

Access to innovative technologies and meaningful work supporting a high-impact federal healthcare program.

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? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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