Manager of Health Plan Quality

Manager of Health Plan Quality 3.3 3.3 out of 5 stars 1300 South Evergreen Park Drive SW, Olympia, WA 98502 $110,000

• $130,000 a year
• Full-time PSW 19 reviews $110,000
• $130,000 a year
• Full-time Summary /

Objective:

The Manager of Health Plan Quality is responsible for leading the strategy, implementation, and performance optimization of HEDIS (Healthcare Effectiveness Data and Information Set) and CMS Star Ratings programs for a Medicare Advantage Organization (MAO). This role drives quality improvement initiatives, ensures regulatory compliance, and partners cross-functionally to improve clinical outcomes, member experience, and overall Star Ratings performance. This position requires deep expertise in Medicare Advantage Stars measures, HEDIS abstraction and reporting, and continuous quality improvement practices.

Essential Functions:

HEDIS Program Management Lead annual HEDIS project planning, execution, and reporting in compliance with NCQA standards. Oversee hybrid and administrative data collection processes, including medical record review and abstraction vendors. Ensure data accuracy, completeness, and audit readiness for

NCQA HEDIS

Compliance Audit. Partner with IT and analytics teams to validate measure logic and data integrity. Support implementation of required tools and platforms Stars Strategy & Performance Develop and execute a multi-year Stars strategy to achieve 4+ Star performance. Monitor and analyze CMS Star Ratings, identifying performance gaps and opportunities. Lead measure-level performance improvement initiatives across domains: o Clinical Quality o Member Experience (CAHPS) o Pharmacy Quality o Operational measures Track performance against benchmarks and implement rapid-cycle interventions. Quality Improvement Initiatives Design and implement provider and member engagement strategies to close care gaps. Collaborate with network providers on value-based care initiatives and performance improvement plans. Support population health programs targeting chronic disease management and preventive care. Regulatory Compliance Ensure alignment with CMS, NCQA, and state regulatory requirements. Maintain readiness for CMS audits, program validations, and reporting deadlines. Stay current with evolving regulations impacting MA Stars and HEDIS specifications. Cross-Functional Collaboration

• Partner with various groups including: o Provider network teams on engagement and incentive alignment o Pharmacy teams for medication adherence measures o Member engagement/marketing for outreach campaigns o Data analytics teams for reporting and insights Act as subject matter expert (SME) for HEDIS and Stars program performance.

Analytics & Reporting Develop dashboards and reports to track performance trends and outcomes. Translate complex data into actionable insights for leadership. Present results, risks, and improvement plans to executive stakeholders. Vendor Management Oversee performance and deliverables of HEDIS abstraction and Stars consulting vendors. Ensure vendor compliance with contractual obligations and timelines. Team Leadership Manage and mentor analysts or specialists supporting HEDIS and Stars functions. Foster a performance-driven, collaborative team culture.

Knowledge, Skills & Abilities:

Analytical and problem-solving skills Strong written and verbal communication Ability to work independently and manage multiple deadlines Collaborative mindset and customer service orientation Detail oriented with a focus on accuracy and compliance. Understanding of Accountable Care Organization and the operations of a Clinically Integrated Network. Ability to navigate conflict and ambiguity with positivity. Required Education and/or

Work Experience:

Bachelor's degree in healthcare administration, Public Health, Nursing, or related field required 3+ years of direct HEDIS and/or Stars program experience with an MAO Proven track record of improving Star Ratings performance Deep knowledge of: o CMS Star Ratings methodology o CAHPS Member Experience & HOS Survey o

NCQA HEDIS

specifications and audit processes o Medicare Advantage regulatory environment Strong analytical and problem-solving skills Experience with healthcare data systems, measure calculation, and reporting tools Ability to lead cross-functional initiatives and influence stakeholders Excellent communication and presentation skills Ability to influence foundational quality strategy and infrastructure Ability to work independently and collaboratively in a fast-paced environment. Preferred Education and/or

Work Experience:

Master's degree (MPH, MHA, MBA) Experience launching a new MAO health plan Experience with

Cotiviti Hedis Engine and Stars Intelligence Required Certificates, Licenses and Registrations:

Valid driver's license.

• PSW does not typically hire at the top of the pay range

Benefits:

401(k) 401(k) matching Dental insurance Disability insurance Flexible Spending Account (FSA) Health Savings Account (HSA) Health insurance Life insurance Paid time off Tuition reimbursement Vision insurance