Provider Quality Program Manager II

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Provider Quality Program Manager II is responsible for coordinating and managing provider quality initiatives designed to improve healthcare quality outcomes and performance measures across Medica's lines of business. This role serves as a key partner between Quality, Clinical Provider Partnerships, Network Management, and operational teams to support provider performance improvement strategies, quality reporting, incentive program administration, and care gap closure efforts.

Working with limited supervision, this position manages assigned projects and program components, prepares and analyzes performance data, develops recommendations, and collaborates with internal and external stakeholders to achieve quality objectives, including Medicare Star Ratings, Medicaid quality, HEDIS performance, and value-based care goals. Performs other duties as assigned.

• Coordinate implementation and ongoing management of provider quality initiatives across assigned provider groups and lines of business
• Support execution of quality improvement strategies focused on Medicare Stars, Medicaid quality measures, HEDIS, and value-based care programs
• Monitor program milestones, deliverables, and outcomes to ensure achievement of established goals
• Provide program management support for cross-functional quality improvement efforts

• Synthesize insights to identify improvement opportunities, emerging risks, and priority areas for intervention.
• Inform and consult on provider performance reports, scorecards, dashboards, and presentations that support organizational and provider decision-making.
• Serve as a quality subject matter expert to clinical provider partnerships team by interpreting performance results, recommending evidence-based improvement strategies, and informing provider engagement discussions.
• Monitor trends and key indicators, providing proactive recommendations and escalating significant risks, barriers, or performance concerns to appropriate stakeholders.
• Evaluate the effectiveness of improvement initiatives and provide ongoing guidance, insights, and best practices to support sustained performance improvement.

• Support administration of provider quality incentive programs, including performance tracking, reporting, and operational processes
• Assist with validating and reconciling provider performance results and attribution methodologies
• Collaborate with finance, network, and quality teams to support accurate incentive calculations and program reporting
• Maintain documentation and operational procedures related to incentive program administration

• Partner with Quality Analytics and HEDIS teams to support collection, validation, and reporting of provider quality data.
• Assist with management of supplemental data submissions and provider data collection activities
• Support chart retrieval, provider communication, and quality data collection efforts as needed
• Ensure data integrity and compliance with regulatory and organizational requirements

• Collaborate with Population Health and Quality Improvement, Clinical Provider Partnerships, Network Management, Value-Based Care Reporting and Analytics, Quality Analytics, HEDIS teams and other Clinical teams to support quality initiatives
• Participate in implementation of quality-related contractual requirements and…