Program Manager II, Quality Reporting & Data Governance

Community Health Plan of Washington•Seattle, WA

1d•$80,940 - $125,460

About The Position

The Program Manager II, Quality Reporting & Data Governance serves as a subject matter expert and strategic partner for quality reporting, data governance, quality assurance, quality control, and regulatory reporting activities. The role supports HEDIS, CAHPS, QHP, HOS, and related quality programs, leading governance activities that promote accuracy, integrity, compliance, and audit readiness of quality reporting deliverables and regulatory submissions. This position facilitates quality assurance and quality control processes, identifies operational risks, recommends corrective actions, and supports continuous improvement initiatives aimed at improving measure performance and adherence to NCQA, CMS, state, and organizational quality standards. The Program Manager develops and manages project plans, facilitates timely and accurate submissions, removes barriers to execution, and collaborates across departments to build sustainable processes that advance quality excellence, successful audit outcomes, and organizational strategic goals.

Requirements

Bachelor’s degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or another relevant academic field, or an equivalent combination of education and/or highly relevant experience.
At least 3 years of experience in program management, preferably related to HEDIS, CMS Star, Value Based Payment Programs, Risk Adjustment, or general healthcare.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint), including advanced Excel functionality.
Experience using SharePoint, Confluence, JIRA, or Smartsheet for project management, workflow tracking, documentation, issue management, operational planning, and cross-functional collaboration.
Knowledge of Medicaid, Medicare, and/or Exchange principles and practices pertaining to CMS, NCQA, PQA, Milliman, and/or Acumen, with an emphasis on quality improvement.
Strong analytical skills, including the ability to interpret data, identify trends, summarize information, and communicate it concisely and clearly.
Strong vendor management, objective targeting, and service level agreement monitoring skills.
Knowledge of and experience applying change management principles, practices, and methodologies.
Ability to adapt to dynamic environments and manage multiple tasks and projects in response to operational demands.
Ability to work independently and collaboratively as part of a team.
Ability to work accurately and meet established deadlines.
Strong organizational skills to ensure efficient and effective operations.
Strong presentation skills, including presenting complex data, reports, and training to groups.
Must successfully pass a criminal background check.
Must not be sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Nice To Haves

PMP, Agile Professional, or other formal project management certification.
Experience in program development, product development, process improvement, and evaluation.
Working knowledge of SQL and/or Snowflake data environments, including the ability to query and validate data, support reporting, investigate data quality issues, and partner effectively with analytics, engineering, and technical teams.
Experience with Community Health Centers (CHC), Federally Qualified Health Centers (FQHC), or other healthcare systems focused on people with low income and/or barriers to equitable healthcare.

Responsibilities

Lead quality assurance and quality control processes for HEDIS, Prospective Medical Record Review (PMRR), CAHPS (Medicaid and Medicare), QHP, HOS, and related quality measurement programs.
Develop, implement, and monitor quality controls to ensure data accuracy, regulatory compliance, audit readiness, and operational consistency.
Partner with internal teams, third-party auditors, and vendors to support compliance, audit readiness, and successful program execution; oversee resolution of audit findings, quality concerns, and compliance risks.
Support the development, implementation, and continuous improvement of quality assurance and quality control frameworks, including validation methodologies, quality reviews, audit protocols, issue tracking, and corrective action plans.
Monitor control effectiveness and recommend ways to reduce risk and improve performance.
Lead validation activities to evaluate the accuracy, completeness, consistency, and reliability of regulatory reporting and performance measurement data.
Conduct root-cause analysis of quality defects, reporting discrepancies, and audit findings; partner with stakeholders and vendors on corrective and preventive actions and stronger data governance.
Coordinate audit readiness strategies, including mock audits, control testing, documentation reviews, quality monitoring, and remediation planning for NCQA, CMS, state, and external audits.
Monitor vendor performance for HEDIS, CAHPS, HOS, PMRR, and other quality initiatives; review performance metrics and contractual compliance, and recommend improvements when gaps are identified.
Facilitate quality governance through documentation standards, reporting controls, adherence monitoring, and communication of quality-related risks, findings, and recommendations to leadership.
Develop and maintain detailed project plans with milestones, tasks, and target and actual completion dates; set SMART goals, allocate resources, track timelines, clear barriers, and escalate risks with mitigation strategies.
Develop program knowledge, stay informed about industry trends, regulatory changes, and best practices, and identify strategic opportunities and improvement strategies aligned with organizational goals.
Maintain stakeholder communication through regular project status, issue, and recovery-plan updates; build professional relationships and keep stakeholders informed and engaged throughout the project lifecycle.

Benefits

Medical, prescription, dental, and vision coverage
Telehealth app
Flexible Spending Accounts and Health Savings Accounts
Basic Life AD&D and short- and long-term disability insurance
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) retirement plan with generous employer match
Employee Assistance Program and Mental Fitness app
Financial coaching and identity theft protection
PTO accrual starting at 17 days per year
40 hours of community service volunteer time
10 standard holidays and 2 floating holidays
Compassion time off and jury duty leave
Annual incentive target of 10% based on company, department, and individual performance goals