Manager, National Risk & Quality Solutions

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager, National Risk & Quality Solutions based in the United States.

This leadership role is responsible for driving quality-system performance, data integrity, and improvement initiatives across a complex healthcare environment.

You will lead a team of quality professionals while overseeing a broad portfolio of data, reporting, and performance-improvement activities.

The role combines people leadership, program management, healthcare analytics, regulatory compliance, and strategic problem-solving.

You will help strengthen quality data processes, close care gaps, and translate complex information into actionable recommendations.

The position works closely with senior leaders, health plans, and cross-functional stakeholders in a highly matrixed organization.

Success requires strong quantitative thinking, regulatory knowledge, organizational discipline, and the ability to simplify complex issues.

This is an opportunity to make a measurable impact on quality outcomes while developing teams and advancing enterprise-wide initiatives.

Accountabilities

• Lead and manage the Quality Systems team, establishing expectations, monitoring performance, coaching employees, and supporting professional development.
• Oversee quality-system performance initiatives and ensure team activities remain aligned with quality strategies, regulatory requirements, and organizational priorities.
• Support annual quality-data submission activities, including NCQA and state regulatory submissions.
• Design and implement data-focused strategies that improve the completeness, accuracy, and reliability of data ingestion, including supplemental and Health Information Exchange (HIE) data.
• Partner with quality leaders and health plans to develop meaningful reporting and analytics covering quality-rate trends and forecasts, provider performance, CAHPS and survey analytics, and health equity.
• Oversee quality project plans, schedules, resource allocation, deliverables, and regulatory compliance.
• Identify project risks and barriers, develop mitigation strategies, and ensure complex issues are appropriately prioritized, escalated, and resolved.
• Analyze quality data to identify issues, determine root causes, and develop actionable recommendations and solutions across business functions.
• Conduct quality reviews and audits, address discrepancies, and maintain consistently high standards of performance.
• Develop data-quality strategies and solutions designed to close quality-of-care gaps.
• Communicate portfolio performance, risks, dependencies, and recommended remediation strategies to leadership and key stakeholders.
• Foster a collaborative, accountable, and high-performing team while hiring, training, developing, and managing employees.

Requirements

• At least 7 years of program or project management experience in healthcare quality, including experience supporting HEDIS activities, targeting, and reporting, or an equivalent combination of education and relevant experience.
• At least 1 year of management or leadership experience.
• Comprehensive understanding of managed healthcare value drivers, quality programs, and the broader healthcare industry.
• Extensive knowledge of healthcare claims and coding elements, including CPT, CPT Category II, LOINC, SNOMED, HCPCS, NDC, CVX, NPI, and TIN.
• Experience running queries using Microsoft Azure and/or SQL Server, with strong data-analysis, manipulation, interpretation, and reporting capabilities.
• Strong quantitative aptitude, critical-thinking, analytical, problem-solving, organizational, and decision-making skills.
• Ability to evaluate cross-functional impacts, weigh costs and benefits for upstream and downstream stakeholders, and develop solutions that create value across multiple business areas.
• Intellectual agility and the ability to simplify and communicate complex concepts clearly to technical and non-technical audiences.
• Proven ability to collaborate with multiple levels of leadership and operate effectively within complex, highly matrixed organizations.
• Strong verbal, written, and presentation communication skills.
• Proficiency with Microsoft Office, particularly Excel, and the ability to quickly learn and navigate new software platforms.
• Experience supporting Medicaid, Medicare, and/or Marketplace programs within a managed-care environment is preferred.
• Advanced knowledge of NCQA, HEDIS, CMS, and state-specific regulatory submission requirements is a plus.
• Advanced Microsoft Azure Databricks and SQL expertise is preferred.
• PMP certification, Six Sigma Green Belt or Black Belt certification, or comparable coursework is advantageous.

Benefits

• Full-time, fully remote position within the United States.
• Annual salary range of $79,607.91-$172,483.80, with actual compensation determined by factors such as location, experience, education, and skills.
• Competitive benefits and compensation package.
• Opportunity to lead a specialized quality team and influence enterprise-wide healthcare quality initiatives.
• Exposure to healthcare analytics, regulatory reporting, quality improvement, and data strategy at scale.
• Opportunities for professional development, team leadership, and cross-functional collaboration.
• Equal-opportunity workplace with reasonable accommodations available to qualified applicants.