Manager, National Risk & Quality Solutions

Job description

**This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager, National Risk & Quality Solutions based in the United States.** This leadership role is responsible for driving quality-system performance, data integrity, and improvement initiatives across a complex healthcare environment. You will lead a team of quality professionals while overseeing a broad portfolio of data, reporting, and performance-improvement activities. The role combines people leadership, program management, healthcare analytics, regulatory compliance, and strategic problem-solving. You will help strengthen quality data processes, close care gaps, and translate complex information into actionable recommendations. The position works closely with senior leaders, health plans, and cross-functional stakeholders in a highly matrixed organization. Success requires strong quantitative thinking, regulatory knowledge, organizational discipline, and the ability to simplify complex issues. This is an opportunity to make a measurable impact on quality outcomes while developing teams and advancing enterprise-wide initiatives. ### Accountabilities - 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, including supplemental and Health Information Exchange (HIE) data. - Partner with quality leaders and health plans to develop meaningful reporting and analytics covering quality-rate trends and forecasts, provider performance, CAHPS and survey analytics, and health equity. - Oversee quality project plans, schedules, resource allocation, deliverables, and regulatory compliance. - Identify project risks and barriers, develop mitigation strategies, and ensure complex issues are appropriately prioritized, escalated, and resolved. - Analyze quality data to identify issues, determine root causes, and develop actionable recommendations and solutions across business functions. - Conduct quality reviews and audits, address discrepancies, and maintain consistently high standards of performance. - Develop data-quality strategies and solutions designed to close quality-of-care gaps. - Communicate portfolio performance, risks, dependencies, and recommended remediation strategies to leadership and key stakeholders. - Foster a collaborative, accountable, and high-performing team while hiring, training, developing, and managing employees. ## Requirements - At least **7 years of program or project management experience in healthcare quality**, including experience supporting HEDIS activities, targeting, and reporting, or an equivalent combination of education and relevant experience. - 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, manipulation, interpretation, and reporting capabilities. - Strong quantitative aptitude, critical-thinking, analytical, problem-solving, organizational, and decision-making skills. - Ability to evaluate cross-functional impacts, weigh costs and benefits for upstream and downstream stakeholders, and develop solutions that create value across multiple business areas. - Intellectual agility and the ability to simplify and communicate complex concepts clearly to technical and non-technical audiences. - Proven ability to collaborate with multiple levels of leadership and operate effectively within complex, highly matrixed organizations. - Strong verbal, written, and presentation communication skills. - Proficiency with Microsoft Office, particularly Excel, and the ability to quickly learn and navigate new software platforms. - Experience supporting Medicaid, Medicare, and/or Marketplace programs within a managed-care environment 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. ## Benefits - Full-time, fully remote position within the United States. - Annual salary range of **$79,607.91–$172,483.80**, with actual compensation determined by factors such as location, experience, education, and skills. - Competitive benefits and compensation package. - Opportunity to lead a specialized quality team and influence enterprise-wide healthcare quality initiatives. - Exposure to healthcare analytics, regulatory reporting, quality improvement, and data strategy at scale. - Opportunities for professional development, team leadership, and cross-functional collaboration. - Equal-opportunity workplace with reasonable accommodations available to qualified applicants.