Remote Health Plan Quality Improvement Lead

St Luke; Boise (ID); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

On-site massages

On-site counseling via EAP

Wellness tool access

Training and career development

Job summary

St. Luke’s is seeking a Quality Improvement Program Manager to lead and coordinate the Health Plan's Quality Improvement Program and accreditation activities.

This role manages the annual QI Work Plan, tracks opportunities for improvement, supports NCQA accreditation, and translates insights into measurable results that improve member outcomes and experience. The role collaborates with accreditation, quality reporting, Stars, provider network, customer service, utilization management, analytics,

Qualifications

• Education: Bachelor’s degree or experience in lieu of.
• Experience: Four (4) years' relevant experience.
• Knowledge of NCQA Health Plan Accreditation standards, Quality Improvement requirements, and quality program governance.
• Experience in health plan quality improvement, population health, healthcare quality management, or healthcare performance improvement.
• Experience supporting quality measure reporting, regulatory audits, accreditation activities, and performance improvement initiatives.
• Experience using healthcare data, quality metrics, and performance reporting to identify opportunities and measure improvement outcomes.
• Project management experience coordinating multiple workstreams, stakeholders, and regulatory deadlines.

Responsibilities

• Lead coordination of the Health Plan Quality Improvement (QI) Program, including management of the annual QI Work Plan, NCQA accreditation requirements, committee activities, annual program evaluation, and oversight of improvement activities and supporting documentation throughout the year.
• Identify, prioritize, and facilitate opportunities for improvement, including development, implementation, and evaluation of interventions and PDSA (Plan-Do-Study-Act) cycles.
• Support annual quality reporting activities, including project plan management, milestone tracking, measure reporting readiness, and quality review of medical record abstraction and overread activities.
• Maintain regulatory and audit readiness documentation and support internal and external reviews related to quality programs, accreditation, and reporting requirements.
• Assist with oversight of chronic care improvement initiatives, including monitoring performance, evaluating outcomes, implementing interventions, and supporting regulatory requirements.
• Prepare reports, presentations, committee materials, and performance summaries that communicate program results, improvement opportunities, intervention outcomes, and accreditation-related activities.
• Partner with quality, operational, analytics, and vendor teams to support quality improvement initiatives and advance organizational goals.

Skills

Quality Improvement

Project management

Healthcare analytics

Stakeholder collaboration

Education

Bachelor's degree or experience in lieu of

Job description

St. Luke’s is seeking a Quality Improvement Program Manager to lead and coordinate the Health Plan's Quality Improvement Program and accreditation activities.

This role manages the annual QI Work Plan, tracks opportunities for improvement, supports NCQA accreditation, and translates insights into measurable results that improve member outcomes and experience. The role collaborates with accreditation, quality reporting, Stars, provider network, customer service, utilization management, analytics,