OverviewThe
Manager of Quality Performance & Reporting is responsible for
leading the organization's MIPS reporting, quality improvement initiatives, and payer quality incentive programs across Together Women's Health practice network. This role serves as the subject matter expert (SME) for MIPS, CMS quality programs, value-based care (VBC) contract quality programs, and new VBC initiatives.
The Manager partners closely with clinical leadership, practice operations, managed care, finance, and analytics to align quality strategy with reimbursement and value-based care objectives.
Remote position with occasional travel to payor meetings or organizational sites as needed.
ResponsibilitiesMIPS Program Leadership- Provide oversight and management of the organization's participation in Physician-Hospital Organization, Value Based Care Initiatives, Clinically Integrated Care models, alternative payment models, and risk-based arrangements.
- Lead the full lifecycle management of the Merit-based Incentive Payment System (MIPS), including measure selection, data validation, monitoring, and submission.
- Oversee reporting across Quality, Promoting Interoperability, Improvement Activities, and Cost categories.
- Ensure compliance with CMS requirements and maintain audit-ready documentation.
- Analyze performance trends and implement strategies to improve composite scores and payment adjustments.
- Provide education to providers and operational leaders regarding MIPS specifications and documentation requirements.
- Monitor annual CMS rule changes and implement operational updates.
Quality Reporting & Incentive Programs- Manage performance tracking for commercial and Medicare Advantage quality programs, including HEDIS, Stars, and other pay-for-performance contracts.
- Identify care gaps and partner with practice leaders to implement corrective action plans.
- Lead workflow optimization initiatives to improve documentation integrity and operational performance.
- Collaborate with Managed Care and Finance to reconcile incentive payments and validate quality-based revenue.
- VBC Contract Quality Oversight - Develops annual performance targets aligned with payer metrics and quality measures.
Data Analytics & Performance Monitoring- Support and maintain dashboards to monitor quality metrics at provider and practice levels.
- Validate EHR and claims-based data integrity.
- Conduct root cause analyses for underperforming measures.
- Provide monthly and quarterly performance reporting to executive leadership.
- Model financial impact of quality performance relative to incentive structures.
Clinical & Operational Collaboration- Work directly with CMO, Physicians, advanced practice providers, and practice managers to drive engagement and accountability.
- Lead interdisciplinary quality meetings focused on performance improvement.
- Support documentation and coding optimization initiatives in partnership with revenue cycle.
- Assist with regulatory surveys and internal audits as needed.
QualificationsEducation- Bachelor's degree in Healthcare Administration, Nursing, Public Health, or related field (required)
- Master's degree (MHA, MPH, MBA) preferred
Experience- 5+ years of healthcare quality, Healthcare performance improvement, or population health experience
- Direct experience managing MIPS reporting required
- Experience with commercial payer incentive programs and HEDIS strongly preferred
- Experience in a multi-site physician group or health system environment preferred
