Manager - Quality Improvement

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

Description

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

What You'll Do

• 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.

• 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.

•  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.

• 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.

Qualifications

• 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.

• 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 quali