Quality Improvement Program Manager

Job Details

The Quality Improvement (QI) Program Manager is responsible for coordinating and supporting quality improvement initiatives across all lines of business within the health plan. This role oversees operational activities related to care gap closure, member outreach events, in-home appointment scheduling, regulatory quality reporting support, and maintenance of quality performance dashboards and work plans. The Program Manager partners closely with clinical, operational, vendor, provider, and regulatory teams to improve quality outcomes, member experience, and regulatory compliance.

Job Description

SummaryThe Quality Improvement (QI) Program Manager is responsible for coordinating and supporting quality improvement initiatives across all lines of business within the health plan. This role oversees operational activities related to care gap closure, member outreach events, in-home appointment scheduling, regulatory quality reporting support, and maintenance of quality performance dashboards and work plans. The Program Manager partners closely with clinical, operational, vendor, provider, and regulatory teams to improve quality outcomes, member experience, and regulatory compliance.Job Duties

• Coordinate and support quality improvement activities designed to improve performance on regulatory and accreditation measures, including HEDIS, Medicare Advantage Stars, Medicaid quality programs, and state-specific initiatives.
• Provide operational oversight for vendor-led in-home appointment campaigns and community events, including member data file creation, secure data transfer, and performance tracking Track outreach activities, appointment completion rates, and event outcomes to ensure performance targets are met.
• Support the Regulatory and Quality Reporting teams with preparation, validation, and submission of required reports to the Department of Human Services (DHS), CMS, NCQA, and other regulatory agencies.
• Design, maintain, and update quality dashboards, scorecards, and performance tracking reports in collaboration with Analytics and Reporting teams. Monitor progress toward organizational quality goals and escalate risks or gaps to leadership.
• Partner with clinical leadership, analytics, provider relations, operations, population health, and regulatory teams to support enterprise quality goals.

Minimum Qualifications

• Bachelor’s Degree
• 2 years working experience in project management required,
• Strong problem-solving, quantitative and analytical skills required.
• Proficient use of Microsoft Office suite (Word, Power Point, Excel) required.
• Strong project management and organizational skills with the ability to manage multiple priorities simultaneously.
• Excellent organizational, interpersonal and time management skills required.
• Ability to organize and manage multiple priorities.
• Ability to work independently and as part of a team.
• Detail-oriented with strong follow-through and accountability.
• Excellent written and verbal communication skills.
• Flexibility is required to deal with diverse situations and a changing environment.
• Ability to quickly learn and implement knowledge of new business processes required.

Additional QualificationsPhysical DemandsLift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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