Quality Programs Manager

company•City of Utica, NY

4d•$79,068 - $142,322

About The Position

Under the guidance of assigned management, the Quality Programs Manager manages complex programs and projects and provides higher-level operational and technical solutions with a holistic, end-to-end approach to quality performance, including accreditation, CMS/DOH regulatory requirements, member experience, and health plan performance. The position is an integral part of the team and serves as the primary contact for internal and external stakeholders on program matters. It provides leadership and direction to ensure submissions meet specifications and deadlines and that results are monitored on an ongoing basis. The manager oversees program operations, compliance, planning, reporting, budgets, resources, risks, vendors, and matrixed teams. The role coordinates evidence collection and submission, monitors program outcomes through reports and dashboards, represents the program in committees, and supports staff and stakeholders through training, coaching, and guidance. It also advances continuous improvement, operational efficiency, and a culture of excellence while protecting confidential information and adhering to applicable privacy, legal, and corporate requirements. The position requires a bachelor’s degree in a related field and at least five years of related work experience, or 11 years of related experience in lieu of a degree. A master’s degree and PMI/PMP certification are preferred. The role is based in a typical office environment, may involve continuous periods of work in a home office, and requires travel across health plan service regions as needed. The salary range is $79,068–$142,322. Remote work may be available on a case-by-case basis.

Requirements

Bachelor’s degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or a related field, plus at least five years of related work experience; alternatively, at least 11 years of related work experience in lieu of a degree.
At least three years of project management experience.
Applied knowledge of quality improvement, accreditation, and regulatory compliance.
Demonstrated leadership skills, knowledge of quality principles, and proficiency in problem solving and quality tools and techniques.
Demonstrated ability to form and foster high-performance cross-functional teams.
Strong verbal and written communication skills, including communication with internal and external audiences across disciplines and organizational levels.
Strong coaching and facilitation skills to drive improvement, matrix ownership, and change.
Strong understanding and application of vendor management skills.
Very strong analytical and business process development skills.
Demonstrated success working in a fast-paced environment.
Demonstrated competence in staff leadership and project leadership tasks.
In-depth knowledge of application delivery, management structures, and reporting procedures.
Demonstrated experience integrating enterprise applications.
Demonstrated experience managing teams executing multi-phase and multi-deployment project schedules.
Demonstrated experience communicating with senior management through discussions, written reports, meetings, and executive presentations.
Knowledge and experience in healthcare, health insurance, or a similar industry.
Ability to work while sitting and/or standing at a workstation and using a computer, keyboard, mouse, and/or phone for three or more hours at a time.
Ability to work in a home office for continuous periods for business continuity.
Ability to travel across health plan service regions as needed.
Ability to lift, carry, push, or pull 15 pounds or less.
Manual dexterity, including fine finger motion.
Ability to hear, understand, and speak clearly while using a phone, with or without a headset.

Nice To Haves

Master’s degree preferred.
PMI/PMP certification preferred.
Knowledge of basic statistical concepts and survey design skills preferred.
Current and thorough understanding of federal and state regulations for all lines of business as they relate to job responsibilities preferred.
Knowledge of federal, state, and accreditation standards, including NCQA, CMS, IHI, AHRQ, NQF, and NYSDOH reporting requirements.

Responsibilities

Manage complex programs and multiple projects, focusing on measures, outcomes, operational optimization, and enterprise-wide priorities.
Manage day-to-day operations and assess organizational compliance with program standards.
Communicate with users, customers, colleagues, sponsors, project teams, and management to review scope and progress and resolve issues or barriers.
Plan, schedule, monitor, and report program activities; develop program plans and ensure milestones and deadlines are met.
Create and present trend reports to executive management throughout the program cycle.
Independently oversee and assess high-visibility projects, manage scope, identify problems, develop and implement solutions, and evaluate outcomes.
Troubleshoot issues, use available resources to find answers, and escalate issues when appropriate.
Develop and maintain progress reports and dashboards with Quality Measurement to assess intervention impact, evidence compliance, and track program status.
Participate in committees and work groups, represent the program, and prepare and present reports, data, and other materials.
Serve as a program and quality subject matter expert and promote awareness of the program’s connection to quality ratings and corporate goals.
Build collaborative relationships with project managers and divisional and cross-functional leaders.
Serve as the primary contact for internal and external program inquiries and manage vendor, auditor, regulator, consultant, site visit, and audit relationships.
Coordinate collection and submission of evidence required for program requirements and assess compliance.
Oversee development, contracting, implementation, and compliance of program-related delegation and vendor agreements; define content, oversight activities, and reporting with business areas.
Provide governance and oversight for program team rooms, artifacts, and schedules.
Organize and facilitate program reviews and meetings with team members and cross-functional stakeholders, ensuring coordination and consistency.
Plan, direct, and coordinate matrixed teams implementing interrelated projects from contract or proposal initiation through final operational stages.
Determine, monitor, and review program costs, budgets, staffing, resources, and risks.
Formulate contingency plans for schedule changes, staffing adjustments, fund allocations, and work requirements.
Control program requirements, scope, and change management; communicate critical-path issues, risks, and mitigation approaches.
Select appropriate tools to estimate and plan team work, produce work plans to required standards, and collaborate on short- and long-term plans.
Establish metrics for key program criteria and monitor results.
Research competitive intelligence and best practices, assess potential implementation, and stay current on emerging technologies, project management techniques, and regulatory and accreditation requirements.
Attend relevant classes, training seminars, and conferences; train and guide staff and implement new requirements across impacted regions.
Educate, assist, and coach staff involved in quality improvement and accreditation activities, including use of quality improvement methods, measurement, analysis, and performance tracking.
Coach and counsel cross-functional teams to complete activities, meet schedules, and resolve technical or operational issues.
Monitor and evaluate the quality of performance and work products within the scope of responsibility.
Promote continuous improvement, efficiency, productivity, waste reduction, and cost reduction, and advance a culture of excellence rooted in customer experience principles.
Maintain confidentiality in accordance with New York State Education Law and Public Health Law and protect member privacy under corporate policies and procedures.
Demonstrate integrity, support the company’s mission and values, follow the Corporate Code of Conduct, and lead according to Lifetime Way values and beliefs.
Maintain regular and reliable attendance and perform other functions assigned by management.