Health Plan Quality Program Mgmt & Performance Manager

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Health Plan Quality Program Management & Performance Manager based in United States. The Health Plan Quality Program Management & Performance Manager will lead quality improvement initiatives and ensure health plan programs comply with state, federal, and industry regulatory requirements. This role focuses on quality management, performance monitoring, and compliance with standards established by NCQA and HEDIS. You will oversee complex quality deliverables, coordinate audits and accreditation activities, and translate regulatory requirements into effective program plans. Working closely with quality leadership and cross-functional teams, you will monitor performance, address compliance gaps, and identify opportunities for continuous improvement. The position combines healthcare quality expertise, analytical thinking, project management, and stakeholder collaboration to strengthen program outcomes. This is a remote opportunity for a Michigan-based professional with experience in Medicaid, managed care, or health plan quality improvement. Accountabilities - Lead quality program management activities to ensure compliance with state and federal regulations and National Committee for Quality Assurance (NCQA) requirements. - Serve as a subject matter expert for the quality management team, providing guidance and support for quality-related projects, programs, and initiatives. - Plan, implement, and maintain quality improvement activities that meet regulatory and reporting requirements. - Prepare and finalize documentation for quality program management committees and other formal meetings, including discussions, participant contributions, follow-up actions, and next steps. - Oversee complex quality management activities, including preparation for quality improvement reports, audits, accreditation surveys, and other required state, federal, and NCQA activities. - Monitor key quality deliverables to ensure they are completed accurately and on schedule, and present findings to departmental leaders, stakeholders, and formal committees.

- Prepare narrative reports, interpret regulatory specifications, explain program outcomes, and document findings in collaboration with quality management colleagues. - Maintain quality program management plans that document applicable state, federal, and NCQA requirements and associated activities. - Collaborate with state and national quality leaders to update policy and procedure addendums and document state-specific requirements. - Create, manage, and compile documentation supporting essential quality improvement functions. - Lead quality improvement meetings and cross-functional discussions to ensure programs meet regulatory and performance standards. - Evaluate program activities and results to identify improvement opportunities and recommend corrective actions. - Partner with quality leadership to investigate escalations, resolve issues, and remediate performance or compliance gaps. - Provide training, guidance, and ongoing support to new and existing quality management team members. - Travel as required to support health plan and state-specific needs, including approximately 0–50% same-day travel and 0–20% overnight travel. Requirements: - At least 6 years of healthcare experience, including a minimum of 4 years in health plan quality improvement, or an equivalent combination of relevant education and experience. - Strong knowledge of HEDIS (Healthcare Effectiveness Data and Information Set) and NCQA quality standards and requirements. - Experience managing quality improvement compliance deliverables related to state and federal regulators. - Familiarity with Michigan Medicaid, managed care, or other government-sponsored healthcare programs.