National Quality Performance Manager (Remote)

About Our Client

The organization operates in the healthcare sector, focusing on quality performance and improvement within health plans. It addresses challenges related to quality measurement, data accuracy, care gap closure, and regulatory compliance to support improved health outcomes and care delivery across diverse populations.

About the Opportunity

The National Quality Performance Manager leads initiatives designed to improve health plan quality performance through data strategy, analytics, reporting, and project management. This role oversees quality improvement initiatives from planning through completion, ensures the integrity and accuracy of quality data, and supports compliance with healthcare quality standards. The position works closely with health plan leaders and cross-functional teams to drive measurable improvements and successful regulatory outcomes.

Responsibilities

• Collaborate with health plan quality leaders to develop and manage quality data strategies, analytics, and reporting.
• Manage quality-related projects from initiation through completion, ensuring timelines, deliverables, and objectives are met.
• Oversee quality data ingestion, validation, reconciliation, and documentation.
• Analyze quality data to identify trends, performance gaps, and opportunities for improvement.
• Ensure quality initiatives align with regulatory audit requirements and support successful audit outcomes.
• Partner with cross-functional teams to maintain data quality and identify and close care gaps.
• Maintain, update, and organize quality program documentation, processes, and supporting materials.
• Communicate project status, risks, findings, and recommendations to stakeholders.
• Build and maintain strong working relationships with internal teams and health plan partners.
• Support continuous improvement initiatives related to quality performance, data integrity, and operational processes.

Requirements

• Minimum of 3 years of program or project management experience in healthcare quality or a related field, or an equivalent combination of education and experience.
• Healthcare industry experience or functional knowledge of healthcare quality programs.
• Ability to simplify complex concepts and communicate them clearly to technical and non-technical audiences.
• Proficiency in data analysis, interpretation, and reporting.
• Strong quantitative, critical-thinking, analytical, and problem-solving skills.
• Excellent attention to detail and strong organizational and project management abilities.
• Ability to collaborate effectively within a matrixed and cross-functional environment.
• Strong verbal, written, and presentation communication skills.
• Proficiency with Microsoft Office and the ability to learn and use new software and technology platforms.

Preferred Qualifications

• Experience with Microsoft Azure and/or SQL queries.
• Knowledge of NCQA, HEDIS, CMS, and state healthcare regulatory requirements.
• Familiarity with healthcare claims and coding systems, including CPT, CPT II, LOINC, SNOMED, HCPCS, NDC, CVX, NPI, and TIN.
• Experience working within managed care organizations supporting Medicaid, Medicare, or Marketplace programs.
• PMP certification.
• Six Sigma Green Belt or Black Belt certification, or comparable coursework.