Quality Program Manager

ZipRecruiter; New York (NY); Remote; USD 80,000 - 120,000; Full time

Job summary

Une entreprise leader dans le domaine de la gestion de la santé recherche un Quality Program Manager pour superviser les projets d'amélioration de la qualité à distance. Le candidat idéal aura une connaissance approfondie du marché de New York, une solide expérience en gestion de la qualité et de l'expertise en métriques de qualité. Ce poste implique de collaborer avec divers partenaires et d'analyser des stratégies d'amélioration basées sur des données.

Qualifications

• 5-8 ans d'expérience professionnelle pertinente requise.
• 3-5 ans d'expérience en gestion de la qualité ou de programme dans un environnement de soins gérés.
• Connaissance approfondie des processus d'accréditation HEDIS/QARR, CAHPS, CMS.

Responsibilities

• Superviser et participer aux projets d'amélioration de la qualité.
• Agir en tant qu'expert en la matière pour les métriques de qualité.
• Collaborer avec des équipes de données pour analyser et rendre compte des initiatives de qualité.

Skills

Project Management

Vendor Management

Quality Metrics Development

Analytical Skills

Communication

Education

Bachelor’s Degree

Master’s Degree

Tools

Microsoft Office

Microsoft Access

Job description

Job Title: Quality Program Manager

Location: Remote (must have knowledge of New York market)

Type: Direct Hire

Overview:
Oversee and actively participate in quality improvement projects that support the organization’s mission of effectively managing members and improving health outcomes. Serve as a liaison between Quality Management and internal/external partners for quality initiatives. Act as a subject matter expert in quality improvement and reporting.

Key Responsibilities:

1. Plan, implement, and oversee quality improvement projects and action plans (HEDIS, CAHPS, and HOS) across Medicare, Medicaid, QHP, and Commercial product lines.
2. Support the execution of centrally developed data-driven strategic plans.
3. Lead or assist in cross-functional collaboration on HEDIS, CAHPS, HOS, Pharmacy, and Enterprise metrics.
4. Serve as the point of contact for quality vendors; develop and distribute target lists; monitor vendor performance against SLAs; maintain communication between vendors and internal teams.
5. Manage ongoing quality programs including Member Rewards & Incentives, Provider Quality Incentives, and health disparity initiatives.
6. Provide subject matter expertise on all quality metrics to internal stakeholders.
7. Support compliance with NCQA, CMS, HEDIS, CAHPS, HOS, and other applicable regulatory requirements.
8. Collaborate with data teams to analyze and report on quality initiatives to inform future strategies.
9. Develop and manage annual performance improvement projects; analyze data and produce final reports.
10. Create methodologies for evaluating quality program outcomes (e.g., ROI, proof points).

Qualifications:

• Bachelor’s Degree required; Master’s Degree strongly preferred.
• Knowledge of the New York Market.
• Project Management or Vendor Management certification.
• 5–8 years of relevant professional experience required.
• 3–5 years of quality or program management experience in a managed care setting required.
• Additional years of experience or certifications may substitute for formal education.
• Proven experience in developing and assessing quality metrics and analytics.
• Strong understanding of contractual or compliance-related Service Level Agreements (SLAs).
• Ability to manage multiple tasks/projects with competing priorities and deadlines.
• In-depth knowledge of HEDIS/QARR, CAHPS, CMS Star Ratings, and accreditation processes.
• Proficient in Microsoft Office (Word, PowerPoint, Excel, Outlook); working knowledge of Microsoft Access.
• Excellent written, verbal, interpersonal, and presentation communication skills.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by federal, state or local laws.