National Manager Quality HEDIS Stars

Overall Purpose

The National Quality Manager directs P3 Health Partners enterprise-wide quality operations and strategy across all markets, driving organizational performance in CMS Star Ratings, HEDIS metrics, CAHPS, and other key quality indicators tied to revenue growth and member outcomes. This role provides senior strategic leadership and executive oversight of quality operations, leading a multi-level team including Quality Operations Supervisors, Senior National Quality Coordinators, and Regional Quality Coordinators across five states (Nevada, California, Arizona, Oregon, and Nebraska). The National Quality Manager sets quality strategy, owns budget and resource management for quality operations, establishes performance accountability for quality metrics, and partners at the executive level with Market leadership, Chief Administrative Officer, Shared Services leadership to ensure quality initiatives align with organizational goals and financial objectives. This position drives organizational change, manages relationships with major health plan partners (Humana, BCBS, Aetna, HealthNet, Alignment Health, Wellcare), and leads P3s quality innovation and competitive positioning in value-based care. Reporting to the National Quality Director, the National Quality Manager is ultimately accountable for quality outcomes, operational efficiency, compliance, and the strategic advancement of P3s quality-first mission across the organization.

Essential Functions

• Develop and execute enterprise-wide quality strategy aligned with P3s organizational vision, financial targets, and competitive positioning. Define annual quality performance targets tied to revenue goals, member experience, and organizational outcomes.
• Lead, manage, mentor, and develop a multi-level quality operations team spanning Quality Operations Supervisors, Senior National Quality Coordinators, and Regional Quality Coordinators across five markets.
• Establish performance expectations, hold teams accountable for outcomes, and develop talent for growth and promotion.
• Own quality operations budget development, strategic allocation, and management.
• Justify investments tied to quality improvement outcomes and organizational revenue impact.
• Monitor spending, optimize resource utilization, and make strategic resource decisions.
• Establish accountability for regional and national quality metric achievement. Monitor HEDIS, CMS Star Ratings, CAHPS, medication adherence, and other quality performance indicators.
• Identify gaps, drive gap-closure strategies, and ensure accountability at all levels of the organization.
• Assist with managing strategic relationships with major health plan partners.
• Assist with design and oversee the execution of enterprise-wide quality initiatives with measurable business impact, including gap-closure programs, CAHPS/HOS campaigns, medication adherence initiatives, chronic disease management programs, and preventive care optimization strategies.
• In conjunction with the National Quality Director, establish quality standards, standard operating procedures (SOPs), and performance frameworks for all quality operations teams. Ensure consistency, efficiency, and scalability across markets.
• Monitor compliance with established standards and quality protocols.
• Provide strategic oversight of HEDIS data management, audit processes, and quality surveillance operations. Ensure accuracy, timeliness, and compliance with NCQA standards and health plan requirements.
• Promotes innovation in quality strategy and approach set by the National leadership team.
• Stay current with industry trends, payer strategies, regulatory changes, and emerging quality benchmarks. Evaluate new quality methodologies and drive adoption of best practices.
• Oversee compliance with HIPAA, CMS, NCQA, and other regulatory requirements across all quality operations and all markets. Manage audit preparation, regulatory submissions, and compliance documentation.
• Develop and present strategic reports to executive leadership, boards of directors, payer partners, and stakeholders on quality performance, organizational transformation, market trends, and strategic recommendations.
• Collaborates with clinical leadership, pharmacy operations, data analytics, finance, human resources, and affiliate operations to ensure quality initiatives are integrated with organizational strategy and capabilities.
• Establish and maintain quality excellence culture across the organization. Model quality-first mindset, drive accountability for outcomes, and inspire teams to deliver exceptional results.

Knowledge, Skills and Abilities

• Executive-level strategic thinking and business acumen. Ability to connect quality performance to organizational revenue, understand competitive positioning in value-based care, and leverage quality as a strategic differentiator.
• Expert-level, comprehensive understanding of HEDIS Technical Specifications, CMS Star Ratings methodology, Medicare Advantage operations, managed care contracting, and payer/provider business models.
• Deep knowledge of HIPAA, CMS regulations, NCQA standards, and healthcare compliance frameworks.
• Ability to manage regulatory relationships and ensure organizational compliance across all markets.
• Ability to lead, develop, and inspire multi-level teams; establish performance accountability; and drive results through others.
• Advanced change management and organizational transformation expertise. Ability to design and lead large-scale organizational changes, manage stakeholder alignment, overcome resistance, and ensure sustainable adoption.
• Strategic relationship management with executive-level peers and external partners. Ability to build trust, influence decision-making, and align stakeholders around quality strategy and initiatives.
• Advanced data analysis and business intelligence expertise. Ability to analyze complex data sets, identify strategic trends, benchmark against industry standards, and derive actionable insights for executive decision-making.
• Expert proficiency in Microsoft Office Suite (Excel, PowerPoint, Word), business intelligence/analytics tools (Tableau, Looker, etc.), and healthcare information systems. Ability to interpret complex databases and design dashboards.
• Strategic thinking and innovation orientation. Ability to anticipate market trends, evaluate emerging quality strategies, and position P3 for competitive advantage in value-based care.
• Project portfolio management expertise. Ability to oversee multiple strategic initiatives simultaneously, manage dependencies, prioritize resources, and drive delivery of complex programs.
• Demonstrated ability to work independently at executive level and as part of C-suite leadership. Strong judgment, decision-making authority, and ability to operate with minimal supervision.

Experience

• Minimum of 10+ years in healthcare, with at least 7 years in executive-level quality operations, quality strategy, or health plan management roles.
• Minimum of 5+ years managing quality operations teams, with demonstrated ability to lead multi-level organizations and drive accountability for outcomes.
• Extensive experience with HEDIS, CMS Star Ratings, Medicare Advantage operations, and quality metrics management.
• Proven track record of developing and executing enterprise-wide quality strategies with measurable organizational impact on quality outcomes and revenue.
• Executive-level experience building and managing relationships with major health plan partners and navigating complex payer negotiations.
• Experience working in multi-market or multi-regional healthcare organizations managing quality operations across multiple locations.
• Proven expertise in healthcare regulatory compliance, audit management, and NCQA relationship management.
• Experience interfacing with executive leadership and boards on quality strategy and performance.

Education & Certifications

• Bachelors degree in healthcare management, business administration, public health, or related field required.
• Masters degree (MBA, MHA, MPH, or similar) strongly preferred.
• Certification in project management, change management, or quality management (PMP, CMC, CQA) a plus.

Licenses

• Valid drivers license with safe driving record and reliable transportation required.

Travel

• Must have ability to travel to markets across five-state footprint.

Work Location & Schedule

This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.

About P3

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.