National Manager Quality HEDIS Stars

Overall Purpose

The National Quality Manager directs P3 Health Partners' enterprise-wide quality operations and strategy across all markets, driving organizational performance in CMS Star Ratings, HEDIS metrics, CAHPS, and other key quality indicators tied to revenue growth and member outcomes. This role provides senior strategic leadership and executive oversight of quality operations, leading a multi-level team including Quality Operations Supervisors, Senior National Quality Coordinators, and Regional Quality Coordinators across five states (Nevada, California, Arizona, Oregon, and Nebraska).

The National Quality Manager sets quality strategy, owns budget and resource management for quality operations, establishes performance accountability for quality metrics, and partners at the executive level with Market leadership, Chief Administrative Officer, Shared Services leadership to ensure quality initiatives align with organizational goals and financial objectives. This position drives organizational change, manages relationships with major health plan partners (Humana, BCBS, Aetna, Health Net, Alignment Health, Wellcare), and leads P3's quality innovation and competitive positioning in value-based care.

Reporting to the National Quality Director, the National Quality Manager is ultimately accountable for quality outcomes, operational efficiency, compliance, and the strategic advancement of P3's quality-first mission across the organization.

Essential Functions

• Develop and execute enterprise-wide quality strategy aligned with P3's organizational vision, financial targets, and competitive positioning. Define annual quality performance targets tied to revenue goals, member experience, and organizational outcomes.
• Lead, manage, mentor, and develop a multi-level quality operations team spanning Quality Operations Supervisors, Senior National Quality Coordinators, and Regional Quality Coordinators across five markets.
• Establish performance expectations, hold teams accountable for outcomes, and develop talent for growth and promotion.
• Own quality operations budget development, strategic allocation, and management.
• Justify investments tied to quality improvement outcomes and organizational revenue impact.
• Monitor spending, optimize resource utilization, and make strategic resource decisions.
• Establish accountability for regional and national quality metric achievement. Monitor HEDIS, CMS Star Ratings, CAHPS, medication adherence, and other quality performance indicators.
• Identify gaps, drive gap-closure strategies, and ensure accountability at all levels of the organization.
• Assist with managing strategic relationships with major health plan partners.
• Assist with design and oversee the execution of enterprise-wide quality initiatives with measurable business impact, including gap-closure programs, CAHPS/HOS campaigns, medication adherence initiatives, chronic disease management programs, and preventive care optimization strategies.
• In conjunction with the National Quality Director, establish quality standards, standard operating procedures (SOPs), and performance frameworks for all quality operations teams. Ensure consistency, efficiency, and scalability across markets.
• Monitor compliance with established standards and quality protocols.
• Provide strategic oversight of HEDIS data management, audit processes, and quality surveillance operations. Ensure accuracy, timeliness, and compliance with NCQA standards and health plan requirements.
• Promotes innovation in quality strategy and approach set by the National leadership team.
• Stay current with industry trends, payer strategies, regulatory changes, and emerging quality benchmarks. Evaluate new quality methodologies and drive adoption of best practices.
• Oversee compliance with HIPAA, CMS, NCQA, and other regulatory requirements across all quality operations and all markets. Manage audit preparation, regulatory submissions, and compliance documentation.
• Develop and present strategic reports to executive leadership, boards of directors, payer partners, and stakeholders on quality performance, organizational transformation, market trends, and strategic recommendations.
• Collaborates with clinical leadership, pharmacy operations, data analytics, finance, human resources, and affiliate operations to ensure quality initiatives are integrated with organizational strategy and capabilities.
• Establish and maintain quality excellence culture across the organization. Model quality-first mindset, drive accountability for outcomes, and inspire teams to deliver exceptional results.

Knowledge, Skills and Abilities

• Executive-level strategic thinking and business acumen. Ability to connect quality performance to organizational revenue, understand competitive positioning in value-based care, and leverage quality as a strategic differentiator.
• Expert-level, comprehensive understanding of HEDIS Technical Specifications, CMS Star Ratings methodology, Medicare Advantage operations, managed care…