Manager, National Risk & Quality Solutions

Jobgether; Deutschland; Remote; EUR 69.000 - 149.000; Vollzeit

Benefits dieser Stelle

Fully remote in the United States

Competitive benefits package

Professional development opportunities

Zusammenfassung

Jobgether, partnering with a United States-based organization, seeks a Manager, National Risk & Quality Solutions to lead a team of quality professionals in a healthcare environment. You will drive data integrity, quality-data submissions, and improvement initiatives across a complex health plan landscape.

You will manage cross-functional projects, translate data into actionable insights, and collaborate with senior leaders to close care gaps.

Qualifikationen

• 7+ years of program or project management experience in healthcare quality.
• 1+ year of management or leadership experience.
• Comprehensive understanding of managed healthcare value drivers and quality programs.
• Knowledge of healthcare claims coding elements (CPT, LOINC, SNOMED, HCPCS, NDC, NPI).
• Experience running queries with Azure and/or SQL Server; strong data analysis and reporting skills.

Aufgaben

• Lead and manage the Quality Systems team, setting expectations and coaching staff.
• Oversee quality-system initiatives ensuring alignment with regulatory requirements.
• Support NCQA and state submissions.
• Design data-focused strategies to improve data completeness and reliability.
• Develop reporting on quality-rate trends, provider performance, CAHPS, and health equity.
• Manage project plans, resources, schedules, and compliance.
• Identify risks, mitigate, and resolve complex issues.
• Analyze data to identify issues, determine root causes, and recommend solutions across functions.
• Conduct quality reviews and audits to maintain high standards.
• Communicate portfolio performance and remediation strategies to leadership.
• Hire, train, and develop a high-performing team.

Kenntnisse

Leadership

Cross-functional collaboration

Regulatory knowledge

Analytical thinking

Communication

Ausbildung

PMP certification

Six Sigma Green Belt/Black Belt

Tools

Microsoft Azure

SQL Server

Azure Databricks

Jobbeschreibung

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager, National Risk & Quality Solutions based in the United States.

This leadership role is responsible for driving quality-system performance, data integrity, and improvement initiatives across a complex healthcare environment.

You will lead a team of quality professionals while overseeing a broad portfolio of data, reporting, and performance-improvement activities.

The role combines people leadership, program management, healthcare analytics, regulatory compliance, and strategic problem-solving.

You will help strengthen quality data processes, close care gaps, and translate complex information into actionable recommendations.

The position works closely with senior leaders, health plans, and cross-functional stakeholders in a highly matrixed organization.

Success requires strong quantitative thinking, regulatory knowledge, organizational discipline, and the ability to simplify complex issues.

This is an opportunity to make a measurable impact on quality outcomes while developing teams and advancing enterprise-wide initiatives.

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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.

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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.