Status: Full-time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F.

Location: Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming 

Overview

• The Manager, Quality Performance and Outreach plays a critical role in driving strategic initiatives to improve STARS, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Performance Withold Program (PWP), and Healthcare Effectiveness Data and Information Set (HEDIS) performance across the health plan and enterprise.

• The position will focus in Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS) for Medicare, and member rewards and data analysis for all lines of business

• Reporting directly to the Director, Quality Performance and Outreach, this position leads cross-functional efforts to design, implement, and evaluate outreach and quality improvement programs that enhance member experience, close care gaps, and support regulatory compliance. 

• The position focuses on all lines of business, including Commercial, Medicaid, and Medicare, collaborating with other health plan departments, providers, vendors and the enterprise. 

• The position will manage a Team of 3 to 6 Direct Reports

Education

• Bachelor’s degree in Nursing, Clinical Sciences, Population Health, Healthcare Administration, Business Administration, or related field REQUIRED

Certification/Licenses

• Registered Nurse License in Virginia OR Compact/Multi-state preferred

Experience

• 3 years of experience with HEDIS, STARS, PWP, or Clinical Improvement REQUIRED

• 3 years of supervisory or management experience REQUIRED

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS) for Medicare

• Prior experience in Project Management and Performance Improvement highly preferred 

• Strong project management and cross-functional collaboration skills REQUIRED

• Ability to interpret clinical data and translate insights into actionable strategies REQUIRED

• Experience working with vendors and managing outreach campaigns REQUIRED

• Health Plan experience is preferred

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $38.22/hour min - $63.70/hour max.  Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities."

To apply, please go to and use the following as your Keyword Search: JR-103770

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Talroo - Health Plan

Keywords: Health Plan, Healthcare, Health Insurance, MCO, Managed Care, Medicaid, Medicare, DSNP, Commercial, Group insurance, Remote, Virginia, VA, Quality, Performance, STARS, Consumer Assessment of Healthcare Providers and Systems, CAHPS, Performance Withold Program, PWP, and Healthcare Effectiveness Data and Information Set, HEDIS, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Health Outcomes Survey (HOS)