Program Manager, Senior
About The Position
The Senior Program Manager will lead planning and execution of annual HEDIS audit operations for the Clinical Quality Analytics team, which oversees clinical quality measurement, HEDIS reporting, and related data and audit operations supporting quality performance, accreditation, and regulatory requirements. Reporting to the Director of Clinical Quality Analytics, this role is the primary operational liaison to external HEDIS audit firms and drives timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables. The role works across HEDIS reporting, Clinical Quality, data analytics, technology, compliance, and other stakeholders to maintain audit readiness, resolve issues, and deliver commitments on schedule. It also coordinates supplemental data source submissions and audit support, maintains status and risk tracking, and improves repeatable audit processes and documentation. The position follows a hybrid workplace model; most teams come into the office two days each week. Employees living more than 50 miles from an office location determine in-office time with their manager based on business need.
Requirements
- Bachelor’s degree, or a high school diploma/GED with four additional years of relevant experience in lieu of a degree.
- At least 5 years of prior relevant program or project management experience, including ownership of complex cross-functional deliverables, milestone tracking, risk management, and stakeholder communication.
- Solid understanding of project and resource management and business acumen, with experience in complex delivery environments.
- Familiarity with enterprise project or portfolio management tools.
- Strong analytical, problem-solving, organizational, written communication, and verbal communication skills.
- Ability to independently drive action and influence stakeholders without direct authority.
Nice To Haves
- Experience with HEDIS reporting and NCQA HEDIS compliance audits, particularly as a liaison to external HEDIS audit firms.
- Experience coordinating virtual HEDIS onsite audits, audit roadmaps, audit information requests, and secure data exchanges.
- Knowledge of health plan clinical quality operations, supplemental data source processes, and audit documentation practices.
- PMP or other relevant project management certification; not required.
Responsibilities
- Lead planning and execution of annual virtual HEDIS onsite audits, including agendas, scheduling, participant preparation, evidence coordination, meeting facilitation, action-item tracking, and closure of follow-up requests.
- Serve as the primary operational point of contact for external HEDIS audit firms; coordinate secure data and documentation exchanges, clarify requests, establish response owners, and monitor submission quality and timeliness.
- Own coordination and completion of the annual HEDIS audit roadmap and integrated workplan, including milestones, accountable owners, dependencies, decision points, and escalation procedures.
- Partner with HEDIS reporting, Clinical Quality, data analytics, technology, compliance, and other stakeholders to maintain audit readiness, resolve issues, and deliver commitments on schedule.
- Coordinate supplemental data source submissions and audit support, including communications with internal and external submitters, documentation collection, and tracking validation and evidence requests.
- Maintain audit status, deliverable, risk, and issue tracking; provide leadership updates, recommend corrective actions, and escalate barriers requiring decisions.
- Improve repeatable audit processes, templates, documentation controls, and cross-functional communication to strengthen readiness and reduce avoidable rework.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
