Program Manager II, Quality Reporting & Data Governance

CHPW•Seattle, WA

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 for HEDIS, CAHPS, QHP, HOS, and related quality programs. The role leads governance activities to promote the accuracy, integrity, compliance, and audit readiness of quality reporting deliverables and regulatory submissions. The position facilitates quality assurance and quality control processes, identifies operational risks, recommends corrective actions, and supports continuous improvement initiatives that improve measure performance and adherence to NCQA, CMS, state, and organizational quality standards. It develops and manages project plans, facilitates timely and accurate submissions, removes barriers to execution, and collaborates across departments to develop sustainable processes that support quality excellence, successful audits, 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, including Word, Excel, Outlook, and PowerPoint, with 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 relating 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 findings, and communicate information 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 business needs.
Ability to work independently and collaboratively, maintain a high degree of accuracy, and meet established deadlines.
Strong organizational skills.
Strong presentation skills, including presenting complex data, reports, and training to groups.
Must successfully pass a criminal background check; criminal history is reviewed case by case.
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 another formal project management certification.
Experience in program development, product development, process improvement, and evaluation.
Working knowledge of SQL and/or Snowflake data environments, including querying and validating data, supporting reporting, investigating data quality issues, and partnering 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 incomes and/or barriers to equitable healthcare.

Responsibilities

Lead quality assurance and quality control processes supporting HEDIS, Prospective Medical Record Review (PMRR), CAHPS for 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 plan processes.
Monitor control effectiveness and recommend ways to reduce risk and improve performance.
Lead quality validation activities assessing 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 to recommend corrective and preventive actions and strengthen data governance processes.
Coordinate audit readiness strategies, including mock audits, control testing, documentation reviews, quality monitoring, and remediation planning.
Ensure organizational preparedness for NCQA, CMS, state, and external audit requirements.
Monitor vendors supporting HEDIS, CAHPS, HOS, PMRR, and other quality initiatives; review performance metrics and contractual compliance and recommend improvements when performance gaps are identified.
Facilitate quality governance by supporting documentation standards, maintaining reporting controls, monitoring adherence to policies and procedures, and communicating quality risks, findings, and recommendations to leadership.
Develop and maintain detailed project plans, including milestones, tasks, and target and actual completion dates.
Set SMART goals, allocate resources, ensure timely execution, track team adherence to timelines, and clear barriers to progress, including team conflict.
Escalate risks and propose mitigation strategies to leadership.
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 regular stakeholder communication about project status, issues, and recovery plans; 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
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
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
Jury duty leave
10% annual incentive target based on company, department, and individual performance goals