Health Plan Quality Program Mgmt & Performance Manager

The Health Plan Quality Program Management & Performance Manager will lead quality improvement initiatives and ensure health plan programs comply with state, federal, and industry regulatory requirements. This role focuses on quality management, performance monitoring, and compliance with standards established by NCQA and HEDIS. You will oversee complex quality deliverables, coordinate audits and accreditation activities, and translate regulatory requirements into effective program plans. Working closely with quality leadership and cross-functional teams, you will monitor performance, address compliance gaps, and identify opportunities for continuous improvement. The position combines healthcare quality expertise, analytical thinking, project management, and stakeholder collaboration to strengthen program outcomes. This is a remote opportunity for a Michigan-based professional with experience in Medicaid, managed care, or health plan quality improvement.

• At least 6 years of healthcare experience, including a minimum of 4 years in health plan quality improvement, or an equivalent combination of relevant education and experience.

• Strong knowledge of HEDIS (Healthcare Effectiveness Data and Information Set) and NCQA quality standards and requirements.

• Experience managing quality improvement compliance deliverables related to state and federal regulators.

• Familiarity with Michigan Medicaid, managed care, or other government-sponsored healthcare programs.

• Strong business writing skills, including the ability to prepare detailed reports, committee documentation, and regulatory deliverables.

• Proficiency in data analysis, manipulation, interpretation, and reporting.

• Strong critical-thinking, analytical, and problem-solving skills, with excellent attention to detail and organizational ability.

• Demonstrated project management experience, including coordinating multiple high-priority deliverables and meeting strict deadlines.

• Ability to implement process improvements, drive change, and work effectively across departments.

• Excellent written and verbal communication skills, including the ability to explain complex regulatory requirements and present findings to stakeholders.

• Ability to work independently in a fast-paced, deadline-driven environment while managing competing priorities.

• Proficiency in Microsoft Office applications, particularly Excel, and the ability to learn new systems and software.

• Clinical licensure or certification may be required when mandated by applicable state contracts, regulations, business operating models, or licensing boards.

Preferred qualifications:

• Previous management or leadership experience.

• Experience with HEDIS data collection and reporting.

• Experience improving Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance.

• State-level quality improvement experience.

• Experience working with government-sponsored programs, including Medicaid, Medicare, or Marketplace plans.

• Professional certification such as Certified Professional in Health Quality (CPHQ) or Certified HEDIS Compliance Auditor (CHCA).

• Registered Nurse (RN) qualification; any applicable license must be active and unrestricted in the state of practice.