Manager, National Risk & Quality Solutions
New
J
JobgetherHealthcare Quality
United StatesFull-TimeManager
Salary79,607.91 - 172,483.8 USD per year
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Job Details
- Experience
- 7 years of program or project management experience in healthcare quality
- Required Skills
- Project ManagementSQLData AnalysisMicrosoft AzureMicrosoft Excel
Requirements
- At least 7 years of program or project management experience in healthcare quality, including HEDIS, targeting, and reporting.
- At least 1 year of management or leadership experience.
- Comprehensive understanding of managed healthcare value drivers, quality programs, and the broader healthcare industry.
- Extensive knowledge of healthcare claims and coding elements, including CPT, CPT Category II, LOINC, SNOMED, HCPCS, NDC, CVX, NPI, and TIN.
- Experience running queries using Microsoft Azure and/or SQL Server, with strong data-analysis and reporting capabilities.
- Strong quantitative aptitude, critical-thinking, analytical, and organizational skills.
- Ability to evaluate cross-functional impacts and communicate complex concepts clearly.
- Proficiency with Microsoft Office, particularly Excel.
- Experience supporting Medicaid, Medicare, and/or Marketplace programs is preferred.
- Advanced knowledge of NCQA, HEDIS, CMS, and state-specific regulatory submission requirements is a plus.
- Advanced Microsoft Azure Databricks and SQL expertise is preferred.
- PMP certification, Six Sigma Green Belt or Black Belt certification, or comparable coursework is advantageous.
Responsibilities
- Lead and manage the Quality Systems team, establishing expectations, monitoring performance, coaching employees, and supporting professional development.
- Oversee quality-system performance initiatives and ensure team activities remain aligned with quality strategies, regulatory requirements, and organizational priorities.
- Support annual quality-data submission activities, including NCQA and state regulatory submissions.
- Design and implement data-focused strategies that improve the completeness, accuracy, and reliability of data ingestion.
- Partner with quality leaders and health plans to develop meaningful reporting and analytics covering quality-rate trends, provider performance, and health equity.
- Oversee quality project plans, schedules, resource allocation, deliverables, and regulatory compliance.
- Analyze quality data to identify issues, determine root causes, and develop actionable recommendations and solutions.
- Conduct quality reviews and audits, address discrepancies, and maintain consistently high standards of performance.
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