Manager, National Risk & Quality Solutions - NCQA

Leads and manages Quality Systems performance managers, demonstrating accountability for people performance, delivery outcomes, and execution of quality system initiatives. Oversees a portfolio of quality data and performance improvement activities, ensuring teams are resourced, aligned, and operating in accordance with quality strategies, regulatory requirements, and enterprise priorities.

• Manages the Quality Systems team, including setting expectations, monitoring performance, providing coaching and feedback, and ensuring alignment with quality strategies and department specific goals.
• Supports the annual quality data submission process, including National Committee for Quality Assurance (NCQA) and state regulatory submissions.
• Manages, designs, and develops data-focused strategies to improve completeness and accuracy of data ingestion activities including supplemental and Health Information Exchange (HIE) data.
• Collaborates with corporate quality leaders and health plans to improve program performance by supporting development of meaningful reporting and analytics including but not limited to: quality rate trending and forecasting, provider quality performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other survey analytics, and health equity.
• Oversees development of quality project plans and schedules, assigns resources, and ensures deliverables are met on time, within scope, and in compliance with regulatory requirements.
• Identifies potential barriers to quality project plans and develops mitigation strategies.
• Ensures complex problems are addressed and resolved by the team through effective prioritization, escalation, and cross-functional collaboration.
• Draws actionable conclusions and collaborates with cross-functional teams to present recommendations/solutions to identify quality issues.
• Conducts regular quality-related reviews and audits to maintain high standards of performance.
• Addresses issues/discrepancies promptly to ensure quality program success.
• Develops data quality strategies and solutions to close quality care gaps.
• Communicates effectively and consistently with leadership and key stakeholders regarding portfolio status, risks, dependencies, and recommended remediation approaches.
• Fosters a collaborative and high-performing team and promotes professional development and knowledge sharing within the team.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality department-specific goals.

• At least 7 years of program/project management experience in quality, including experience supporting HEDIS activities targeting and reporting, or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Comprehensive mastery of the drivers of value in managed health care, and in-depth knowledge of quality and the health care industry.
• Extensive knowledge and mastery of the nuances of health care claim elements including:
  Current Procedural Terminology (CPT), CPT Category II (CPTII), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine - Clinical Terms (SNOMED), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), CVX Codes (CVX), National Provider Identifiers (NPIs), and Taxpayer Identification Numbers (TINs).
• Experience running queries in Microsoft Azure or Structured Query Language (SQL) server.
• Ability to assess impact cross-functionally, identify costs/benefits to upstream and downstream stakeholders, and solution benefits to multiple business areas.
• Intellectual agility and ability to simplify and clearly communicate complex…