Manager-Quality Improvement (Full-time Remote, North Carolina Based)

The Manager of Quality Improvement provides leadership and operational management of Alliance Health’s Quality Improvement (QI) Program, ensuring alignment with organizational goals, regulatory requirements, and accreditation standards. This position is responsible for translating organizational, regulatory, contractual, and quality priorities into structured improvement initiatives that produce measurable improvements in member outcomes, service quality, organizational performance and health equity.

The manager leads the development of quality improvement initiatives through the application of recognized quality improvement methodologies, data driven approaches, and performance improvement frameworks to drive measurable improvements in quality, access, member experience, and health outcomes. The Manager oversees Performance Improvement Projects (PIPs), quality analytics, data validation, performance measurement, reporting, and regulatory submissions, while ensuring compliance with federal and state Medicaid managed care requirements, accreditation standards, and contractual obligations.

Quality Improvement

• →The role serves as a leader in quality improvement, healthcare analytics, regulatory compliance, performance management, utilizing data-driven insights to identify opportunities, monitor outcomes, and support organizational decision-making
• →Execute, deliver, and lead quality strategy, annual work plans, quality committees, governance activities, continuous quality improvement culture, and enterprise quality initiatives
• →Oversee development, review, implementation, evaluation, and reporting of PIPs, corrective action plans, quality initiatives, state reports, and regulatory deliverables
• →Evaluate intervention effectiveness and sustainability
• →Analyze quality, utilization, access, operational, and member experience measures. Calculate absolute and relative change, benchmark comparisons, trend analyses, and identify meaningful performance variation
• →Advanced knowledge of Medicaid managed care quality programs, State deliverables, PIPs, QAPI, HEDIS, quality improvement analytics and statistical interpretation methodologies including absolute and relative change calculations, PDSA, Root Cause Analysis, PDSA, Driver Diagrams, process mapping, SMART AIM development etc.
• →Incorporate assessment and evaluation of disparities, access barriers, social drivers of health, equity opportunities, and support the development of targeted interventions to improve outcomes
• →Stakeholder consultation and collaboration, change management concepts.
• →Collaborate with Medical Management, Care Management, Provider Network, Population Health, Analytics, Compliance, Operations, and Executive Leadership to advance quality initiatives across the organization
• →Maintain compliance, confidentiality, ethical standards, professional credibility, and current knowledge of healthcare quality trends

Performance Measurement and Data Analysis

• →Partner with Clinical Quality Analytics, HEDIS Performance Team, Population Health, Information Technology, and other teams to identify and monitor meaningful quality indicators
• →Interpret performance trends and translate data into actionable improvement strategies. Identify signals of improvement, remaining gaps, unintended consequences, sustainability risks, and next best tests of change
• →Validate that improvement measures appropriately assess whether interventions are producing intended outcomes
• →Responsible for the development of reports, dashboards, and executive presentations to support Quality Improvement initiatives with internal and external stakeholders, including the NC DHHS
• →Present complex performance information in a clear, actionable format for operational and executive audiences

People Leader

• →Work with Human Resources to attract, maintain, and retain a highly qualified and well-trained workforce
• →Directly supervise staff, conduct evaluations, provide coaching, manage productivity, support hiring, onboarding, retention, and workforce development
• →Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• →Ensure all staff are treated with respect and dignity
• →Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• →Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• →Support a learning environment and culture of quality to advance team skills and professional development
• →Cultivate and encourage efforts to expand cross-team collaboration and partnership
• →Build relationships and identify gaps with partnerships across the organization and with external/community stakeholders to support program operations

Manager Operational Functions

• →Manage and ensure compliance with organizational policies and labor law requirements for timesheets, time off utilization, and overtime utilization
• →Monitor team member productivity, progress towards goals, and measure against KPIs
• →Collaborate with supervisor, and HR as needed, regarding formal coaching notes, written warnings, and performance improvement plans
• →Direct coaching through 1:1 check-ins with assigned staff
• →Facilitate at least monthly team meetings to review operations updates and expectations
• →Ensure that the team has the needed tools and resources to achieve outreach goals and ensure compliance with regulatory and accreditation requirements, with recommendations and advocacy for the appropriate resources
• →Accountable to ensure organized workflows that contribute to staff understanding of their roles and responsibilities

Professional Integrity

• →Foster a collaborative, inclusive, and positive work environment
• →Maintain composure and efficiency in high-pressure situations, ensuring all tasks are completed within established timelines
• →Handle sensitive situations with tact and professionalism, fostering positive relationships both internally and externally
• →Adhere and monitor staff compliance with all Alliance Organizational Policies and Procedures
• →Conduct self for alignment with system strategy, vision, mission, and values and ensure support of department specific goals and objectives
• →Maintains knowledge of current trends, evidence-based practices in the field

Education & Experience

Required: 

Bachelor’s degree in healthcare administration, Public Health, Nursing, Health Informatics, Business Administration or related healthcare field and five (5) years of healthcare quality improvement, analytics, population health, or performance improvement experience including two (2) years of leadership experience and health plan quality experience.

Preferred: 

Master’s degree (MPH, MHA, MBA, Nursing, Epidemiology, Biostatistics, Informatics, Population Health) and five (5) years of healthcare quality improvement, managed care, analytics, population health, or performance improvement experience and three (3) years of leadership experience and health plan quality experience.

Certified Professional in Healthcare Quality (CPHQ), Lean Six Sigma Black Belt (LSSBB) preferred.

• Computer proficiency in Microsoft Excel, Teams, Word and Outlook.
• Ability to utilize computer equipment and web-based software to conduct work.
• Ability to interact with various office staff as needed to support necessary workflows.
• Ability to communicate effectively to individuals and groups through spoken, written and electronic media.
• Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.
• Ability to work independently without a high degree of supervision.
• Knowledge of Medicaid Managed Care Organizations
• Knowledge of NCQA, HEDIS, DHHS, and Value-Based Care 
• Knowledge of physical and behavioral health, SDOH, Access, and other influences of health

$79,425 -$101,267/Annually