Quality Improvement Program Manager

This role oversees quality improvement initiatives across all lines of business within the health plan, focusing on care gap closure, member outreach, regulatory reporting, and performance tracking.

Responsibilities

• Coordinate and support quality improvement activities designed to improve performance on regulatory and accreditation measures, including HEDIS, Medicare Advantage Stars, Medicaid quality programs, and state-specific initiatives.
• Provide operational oversight for vendor-led in-home appointment campaigns and community events, including member data file creation, secure data transfer, and performance tracking.
• Track outreach activities, appointment completion rates, and event outcomes to ensure performance targets are met.
• Support the Regulatory and Quality Reporting teams with preparation, validation, and submission of required reports to the Department of Human Services (DHS), CMS, NCQA, and other regulatory agencies.
• Design, maintain, and update quality dashboards, scorecards, and performance tracking reports in collaboration with Analytics and Reporting teams.
• Monitor progress toward organizational quality goals and escalate risks or gaps to leadership.
• Partner with clinical leadership, analytics, provider relations, operations, population health, and regulatory teams to support enterprise quality goals.

Requirements

• Bachelor’s Degree.
• 2 years of working experience in project management.
• Strong problem-solving, quantitative, and analytical skills.
• Proficient use of Microsoft Office suite (Word, PowerPoint, Excel).
• Strong project management and organizational skills with the ability to manage multiple priorities simultaneously.
• Excellent organizational, interpersonal, and time management skills.
• Ability to work independently and as part of a team.
• Detail-oriented with strong follow-through and accountability.
• Excellent written and verbal communication skills.
• Flexibility to deal with diverse situations and a changing environment.
• Ability to quickly learn and implement knowledge of new business processes.

Physical Demands

• Lift and carry 25 lbs.
• Frequent sitting/standing.
• Frequent keyboard use.

Benefits

• Comprehensive package including medical (including prescription), dental, vision, life, and AD&D insurance.
• Short- and long-term disability coverage.
• Flexible spending accounts.
• Retirement plans.
• Tuition assistance and discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service.
• Voluntary benefits, including group rates on insurance and discounts.
• Access to medical (including prescription) insurance for all colleagues, including part-time and per diem staff.

Schedule

Workday Day (United States of America)

Located at 1101 Market, Philadelphia, Pennsylvania, United States of America.