Full-Time Sr. National Quality Contract Manager

• Responsible for analyzing data, diagnosing root causes, and implementing specific, repeatable processes that drive meaningful quality outcomes.
• Serving as a primary point of contact for complex quality challenges, the Senior Manager works to enhance performance in models like Stars, HEDIS, and MIPS, ensuring compliance and directly reducing the burden on providers and care teams.
• Engage directly with Market and Provider teams to analyze and address specific contract quality challenges, designing and executing targeted solutions that drive measurable improvements in quality outcomes.
• Build, refine, and enforce repeatable processes that ensure the organization meets its annual contract quality goals, translating high-level objectives into practical, day-to-day actions for operational teams.
• Drill down into and resolve complex challenges in clinical quality and transitional care domains, directly impacting patient outcomes and contract performance.
• Use data to assess the effectiveness of various contract quality initiatives in the near term and make adjustments as necessary.
• Translate complex regulatory requirements from models like STARS, HEDIS, and MIPS into clear, actionable workflows for Market Teams and Providers, ensuring they have the tools to achieve compliance and strong performance.
• Work with Analytics and Market leaders to develop and enhance contract quality reporting tools.
• Actively partner with Technology and Analytics teams to spec out, test, and deploy tools and automations that directly reduce administrative burden on care teams, enabling them to focus on patient care.
• Promote and clearly document the use of standardized processes to ensure consistency and efficiency across the organization.

• 3+ years of relevant working experience
• Strong project management and data analytics skills
• Strong presentation and communication skills
• Medical record reviewing/ measure compliance expertise
• Healthcare experience required; Experience with Quality programs such as MSSP, CMS MedicareAdvantage Star Ratings or HEDIS strongly preferred
• Strong knowledge of Excel
• Must comply with HIPAA rules and regulations

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