Responsibilities
The Quality Operations Manager is responsible for national quality operations across HarmonyCares’ programs (MA Stars, MSSP MIPS APP, and ACO REACH). The role establishes the standard for how quality work is executed at scale by operationalizing annual measure and specification updates through enterprise playbooks and provider / care team education, executing centralized EMR chart abstraction to accelerate gap closure, and serving as the Tier 2 escalation point for complex denominator and closure documentation issues. This role drives continuous improvement by identifying recurring breakdowns and implementing workflow and training updates that reduce rework and improve performance. This position supports consistent field execution and contributes to achievement of enterprise quality targets, including 4+ Stars performance and comparable goals for MSSP MIPS APP and ACO REACH.
Essential Duties and Responsibilities
- Maintain national quality playbooks and a shared knowledge base and keep guidance current with annual measure and specification updates and field feedback
- Drive continuous process improvement by analyzing recurring closure misses and field questions, then implementing workflow changes, job aids, and targeted education to improve closure rates and reduce rework
- Deliver provider / care team education, including new provider onboarding and ongoing continuing education, with practical “how to close” training and examples of acceptable evidence
- Align stakeholders without formal authority and drive adoption of standard work across regions
- Execute centralized EMR chart abstraction to identify qualifying evidence and document a traceable evidence trail to support closure of contracted quality gaps
- Manage the Tier 2 escalation queue for complex denominator and closure documentation issues
- Provide consistent guidance and closed-loop resolution back to Sr. Population Health Managers
- Support audit readiness by reinforcing documentation and evidence traceability standards, completing readiness checks and spot audits, and coordinating auditor-facing requests
In this role you may work with. . .
- Senior Population Health Manager
- Executive Directors
- Clinical and administrative field teams
Qualifications
REQUIRED Knowledge, Skills and Experience
- Bachelor’s degree or equivalent combination of education/experience in quality, population health, healthcare operations, or a related field
- 4+ years of experience in MA Stars quality operations and measure execution
- Stays current on Stars, MSSP MIPS APP, and ACO Reach quality program updates and translates changes into playbooks, education, and operational guidance
- Strong working knowledge of denominator logic, closure mechanics, acceptable evidence standards, and common failure modes
- Proficient locating discrete qualifying evidence (labs, screenings, results, reports) and documenting a clear, traceable evidence trail while navigating EMR workflows at speed
- Strong PowerPoint skills for playbooks, job aids, and training and advanced Excel skills for trackers and QA logs
- Demonstrated experience developing enterprise playbooks, workflows, job aids used across multiple markets or teams
- Demonstrated experience supporting clinical and field team education, including new hire onboarding and ongoing continuing education
- Demonstrated proficiency performing medical record review and chart abstraction to identify qualifying evidence and support quality gap closure. Athena and/ or Navina experience is a plus
- Experience operating in a matrixed environment with competing priorities and time-sensitive deliverables
Preferred Knowledge, Skills and Experience
- Clinical credential (RN/LPN) or equivalent experience in HEDIS/Stars abstraction, coding, or health information management
- Relevant certifications such as CPHQ, Lean/Six Sigma, or PMP
- Experience supporting audit readiness activities, including evidence traceability standards and responding to payer or auditor requests
- Experience with MSSP MIPS APP and ACO REACH quality programs
Posted Max Pay RateUSD $120,000.00/Yr.
Posted Min Pay RateUSD $84,000.00/Yr.
Pay TransparencyIndividual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations.
