[Remote] Quality Program Development Manager

Note: The job is a remote job and is open to candidates in USA. reputed company is transforming the health of communities across the U.S. and is seeking a Quality Program Development Manager to reputed company the development and implementation of quality standards and procedures in healthcare. This role involves managing regulatory deliverables, driving quality improvement initiatives, and collaborating with cross-functional teams to enhance clinical and operational quality.

Responsibilities

• Own regulatory and accreditation deliverables (NCQA, PIPs, state requirements), ensuring on-time submission and sustained audit readiness
• Drive audit readiness by establishing and maintaining scalable documentation, workflows, and submission processes that support compliance and reduce risk
• reputed company performance data to identify gaps, reputed company root cause analysis, and drive targeted quality improvement initiatives that enhance outcomes
• Oversees the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration
• Designs and facilitates the development of various programs/systems, work flows, and integration efforts in alignment with Corporate, market, contractual, regulatory and quality requirements
• Acts as the content and technical subject matter expert to the operation managers and directors for key project initiatives including the development of detailed work plans, facilitating reputed company cause analysis, identifying and socializing process enhancements, setting deadlines, assigning responsibilities, and monitoring/summarizing project reputed company
• Prepares strategic analysis of potential business and/or operational opportunities in relation to new business, rebids, and QI targets using customized solutions
• Conducts needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner
• Partners with leaders and members of the Quality Analytics and Improvement Teams and determines data needs as well as assists in designing tools and reports as necessary
• Partners with clinical and operations staff with consulting and analysis services to support initiatives intended to reputed company breakthrough or incremental process improvement in patient quality of care
• Conducts other responsibilities as needed
• Performs other duties as assigned
• Complies with reputed company policies and standards

Skills

• Must be authorized to work in the U.S. without the need for employment-based reputed company sponsorship now or in the future
• A Bachelor's Degree in a reputed company field, or equivalent work experience in Business, HC Management, or Nursing
• 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment
• 3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH
• 2+ years of experience in design, reputed company and implement STARS, CAHPS, HEDIS and other enterprise quality reputed company programs across a variety of settings including: Defining the eligible population, service mix, delivery system configuration and financing, Integration of behavioral, clinical, social, and community health care for members with multiple chronic conditions, Working with multiple market leaders to coordinate consistent quality initiatives, Conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide
• A Master's Degree in a reputed company field: Business or HC Management (MBA, MHA, MPH, MSN)
• Six reputed company Certification
• Lean Certification
• Certified Professional in Healthcare Quality (CPHQ)
• Expertise in regulatory compliance and accreditation (NCQA, PIPs, Medicaid/Medicare)
• Experience leading cross-functional initiatives in fast-paced, deadline-driven environments
• Ability to analyze healthcare performance data and drive targeted quality improvements
• Strong skills in audit-ready documentation, reporting, and process improvement
• Background in managed care, quality, or program development (3–5+ years)

Benefits

• reputed company
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.

Company Overview