Quality Improvement Hedis Program Manager Jobs (NOW HIRING)

Department: Quality - Operations

Employment Type: Full Time

Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919

Reporting To: Leigh Nyahe

Compensation: $90,000 - $110,000 / year

About the Role

The Manager, Quality Improvement is responsible for leading quality improvement initiatives that support performance across HEDIS, Medicare Stars, and other quality programs. This role collaborates with providers, health plans, IPA partners, and cross-functional teams to improve quality outcomes, close care gaps, enhance provider performance, and support organizational quality goals. The Manager provides operational leadership for assigned quality programs, regional quality operations, provider engagement activities, regulatory compliance, and quality performance initiatives while developing high-performing teams and fostering a culture of accountability and continuous improvement.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

Quality Performance & Program Management

• Lead day-to-day operations for assigned quality programs, regions, projects, and lines of business, ensuring achievement of key quality measures and performance goals.
• Monitor health plan quality metrics and ratings, identify performance gaps, and implement improvement initiatives to drive measurable outcomes.
• Partner with regional and cross-functional stakeholders to develop and execute care gap closure and quality improvement strategies.
• Analyze performance trends and communicate findings, risks, barriers, and recommendations to leadership, providers, and health plan partners.
• Oversee quality data workflows and reporting processes to ensure accurate, complete, and timely submission of required data.

Provider & Health Plan Engagement

• Lead meetings with health plans, IPA partners, providers, and operational stakeholders to review performance, address opportunities, and advance quality improvement initiatives.
• Drive provider engagement and education efforts supporting HEDIS, Medicare Stars, NCQA measures, value‑based care objectives, and compliant care gap closure activities.
• Serve as a subject matter expert on quality measures, NCQA standards, and quality improvement best practices.
• Present performance updates, recommendations, and best practices while maintaining strong relationships with health plans and external partners.

Leadership & Team Development

• Manage, mentor, and develop a team responsible for provider engagement, outreach, and quality improvement activities.
• Lead recruitment, onboarding, performance management, coaching, and professional development efforts to build and retain a high-performing team.
• Foster a culture of collaboration, accountability, continuous improvement, and service excellence in partnership with Human Resources and department leadership.

Compliance & Operational Excellence

• Support payer audits, regulatory reviews, and delegated oversight activities while ensuring compliance with contractual, regulatory, and NCQA requirements.
• Identify operational risks and barriers, implement corrective actions, and ensure consistent execution of quality initiatives across assigned markets and provider networks.
• Participate in regional meetings and support organizational priorities, special projects, and other duties as assigned.

Education

• Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, or a related field preferred, or equivalent combination of education and progressively responsible experience.
• Master's degree preferred.

Experience

• At least 5 years of experience in healthcare quality improvement, HEDIS, Medicare Stars, population health, managed care, or related healthcare programs.
• At least 2 years of leadership experience managing teams, projects, or quality improvement initiatives.
• Experience working with health plans, IPAs, provider organizations, ACOs, MSOs, or value‑based care programs preferred.
• Experience driving measurable improvements in quality performance metrics and care gap closure initiatives.
• Strong understanding of NCQA quality programs, HEDIS measures, and Medicare Star Ratings.

License/ Certifications (if applicable

• Lean Six Sigma certification preferred.
• Certified Professional in Healthcare Quality (CPHQ) or other relevant healthcare certification preferred.

Knowledge, Skills, and Abilities

• Strong knowledge of value‑based care, managed care operations, HEDIS, Medicare Stars, NCQA standards, and quality improvement methodologies, including the ability to interpret and apply quality measure requirements.
• Strong analytical, critical‑thinking, and problem‑solving skills with the ability to translate data into actionable strategies and operational improvements.
• Excellent leadership, organizational, stakeholder management, and communication skills, with the ability to influence across matrixed teams and manage remote staff.
• Proficiency in provider relationship management, presentation delivery, and cross-functional collaboration to drive performance outcomes.
• Intermediate proficiency in Microsoft Excel, PowerPoint, reporting tools, and data analysis applications.
• Demonstrated professionalism, accountability, integrity, attention to detail, and the ability to balance operational execution with organizational priorities.

Preferred Qualifications

• Experience managing HEDIS, Medicare Stars, quality improvement, population health, provider performance, or regional quality operations programs.
• Experience working within Medicare Advantage, Medicaid, Commercial, or other managed care environments.
• Experience leading provider engagement, education, quality performance improvement, and cross-functional initiatives.
• Experience supporting health plan delegation, audits, regulatory compliance activities, and quality‑related reporting and analytics.

• This position may oversee and collaborate with employees and partners in remote, office, and regional settings.
• Travel up to 25% may be required to support assigned regions, provider groups, and corporate offices.
• The employee must be able to attend meetings in person or virtually based on business needs.
• The employee must comply with Astrana Health policies and procedures regarding patient privacy, protected health information, and all applicable federal and state regulations.