Senior Manager, Quality Programs

Firefly Health•Watertown, MA

3h•$120,000 - $140,000•Remote

About The Position

Firefly Health is building a revolutionary new type of comprehensive health "care and coverage,” powered by a relationship-driven care team, a trusted virtual and in-person clinical network, and our proprietary technology platform. Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver clinical and financial health through joyful, always there care. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members. We are intensely focused on optimizing the physical + mental + financial wellbeing of those who want (and deserve) something better than the status quo. If you are ready to roll up your sleeves and take on our audacious mission, we would love to hear from you. As the Senior Manager of Quality Programs at Firefly Health, you will be the technical expert and operational engine driving the next chapter of our value-based care and population health performance. Firefly has built a strong clinical quality foundation. Reporting directly to the Senior Director, Clinical Operations and partnering closely with Clinical leadership, you will own the full lifecycle of our quality metric performance management. While this role has no direct reports, it is a highly matrixed leadership position. You will use your strong influencing skills to leverage and align peer resources across Care teams, Operations, and Marketing—ensuring our teams are always oriented toward the right populations at the right time.

Requirements

5-7 years of experience in healthcare operations, population health, or quality improvement, with a strong command of healthcare quality metrics, HEDIS measures, and value-based care frameworks.
A proven track record of effectively influencing and collaborating with cross-functional teams (Clinical, Data, Product, Marketing, and Operations) to improve processes and workflows without direct line-management authority.
Experience managing complex, multi-phased projects with longer horizons, specifically scaling operational workflows or transitioning processes between teams.
Demonstrated ability to use independent judgment and professional creativity to solve data and operational challenges.
Strong proficiency working with data tools (Looker preferred), EHR systems (Elation preferred), and spreadsheets to turn raw data into actionable outreach strategies.
Meticulous attention to detail to ensure our internal documentation and tracking perfectly match what payers and regulators expect.

Nice To Haves

You hold an active RN license with commensurate clinical & operational experience
You hold a Certified Professional in Healthcare Quality (CPHQ) certification
You have previously worked within quality operations or designed population health programs directly within a Health Plan environment
You have a PMP certification or formal training in managing complex, cross-functional timelines

Responsibilities

Design outreach calendars and target logic to bundle clinical care gaps, creating a low-friction experience for members and teams.
Provide Marketing, Operations, and Care Teams with clinically validated patient lists and clear calls to action.
Create pre-approved scripts, macros, and escalation paths.
Monitor enterprise quality scores and manage long-horizon milestones for NCQA re-accreditation, health equity, and annual plan audits.
Partner with the Data team to review external claims, resolve quality gap discrepancies, and maintain a clean source of truth.
Collaborate with clinical stakeholders to optimize documentation logic in the EHR (Elation) for automated metric capture.
Expand proven screening processes from traditional primary care panels to our rapidly growing Firefly Health Plan population.
Partner with clinical leadership to set EHR triggers, target rules for rising-risk populations, and large-scale data ingestion logic.
Partner with Marketing on automated preventative care campaigns, and collaborate with Product/Data to map HEDIS logic and member-facing nudges.
Assess quality requirements and operational lift for prospective contracts and new markets.
Maintain a central playbook of quality benchmarks and synthesize complex data into narratives for MBRs, Board decks, and payer meetings.
Supply Client Success teams with gap-closure reports that demonstrate clinical excellence and ROI during reviews.