Senior Quality Improvement Manager - Health Plan

Astiva Health, Inc.; Orange (CA); On-site; USD 120,000 - 180,000; Full time

Job summary

Astiva Health, Inc. in Orange, CA, is seeking a Manager of Quality Improvement to lead Quality Management, Quality Improvement (QI), risk adjustment, and Quality Assurance initiatives.

This role directs strategy, performance improvement, and compliance to advance STAR ratings and overall program effectiveness. You will collaborate with senior leadership, guide staff, supervise audits, and ensure alignment with Medicare/HMO requirements while reporting progress to key committees and the Board.

Qualifications

• 7+ years senior-level Managed Care operations experience
• Master’s in Public Health, Health Science, or RN/NP/BSN licensure
• 5+ years QI experience at the plan level preferred
• Experience with HMO, Medi-Cal/Medicaid, Medicare, insurance, or relevant government/public service preferred
• Board reporting and strategic planning experience preferred
• Experience overseeing delegated medical groups, IPAs, and contracted healthcare entities

Responsibilities

• Develop strategy and deploy systems for Quality Management, Quality Improvement, and Quality Assurance.
• Ensure compliance with federal, state, and local requirements and reporting standards.
• Lead STAR-related initiatives (HEDIS, CAHPS, HOS) and risk adjustment improvements.
• Design monitoring and reporting processes, align deliverables with budgets.
• Oversee QI program reviews, policies, and procedures; report to Utilization Management/QA Committee and Board.
• Recruit, manage, and develop staff while ensuring effective collaboration with internal departments.

Skills

Leadership

Strategic thinking

Communication

Policy interpretation

Education

Master’s in Public Health or Health Science

RN/NP/BSN licensure

Tools

HEDIS/STARS analytics

Job description

Astiva Health, Inc. in Orange, CA, is seeking a Manager of Quality Improvement to lead Quality Management, Quality Improvement (QI), risk adjustment, and Quality Assurance initiatives.

This role directs strategy, performance improvement, and compliance to advance STAR ratings and overall program effectiveness. You will collaborate with senior leadership, guide staff, supervise audits, and ensure alignment with Medicare/HMO requirements while reporting progress to key committees and the Board.