Quality Manager

Executive Management Oakland, California



Job Description

Job Title:

Manager, Quality

FLSA Status:


Job Code:


Pay Grade:


Date/Revision Date:


















Job Summary & Responsibilities





Job Summary

This position will be responsible for overseeing the specific strategic and tactical initiatives designed to achieve and maintain a 4 - 5 Medicare Star rating for HEDIS and CAHPS performance measures. This position will provide management oversight of a cross functional team responsible for developing measure-specific goals and detailed plans for achieving the expected goals.



Essential Functions

  • Monitor and leverage best practices from other 4-5-star plans to continuously improved HEDIS, CAHPS, and Stars Performance
  • Works collaboratively with cross-functional teams to utilize analytics for member stratification and care gap closure.
  • Develops roadmap that defines the path to operationalize specific actions, which are repeatable, measurable, and cost-effective.
  • Collaborates with analytics team to measure the effectiveness of initiatives and process improvements.
  • Leads, coaches, and instructs process owners and improvement teams in the definition, documentation, measurement, improvement, and control of processes aimed at optimizing the quality of the Medicare Stars program.
  • Creates and leads cross-departmental initiatives to change processes such that members garner improved satisfaction with the health plan and are less inclined to dis-enroll.
  • Acts as one of the subject matter expert to all teams involved in impacting Stars, CAHPS and HOS performance.
  • Share best practice to improve provider processes and workflows for optimal Stars, CAHPS, and HOS ratings.
  • Evaluates the effectiveness of existing operational metrics, developing new metrics as necessary, to better assess the performance of organization in achieving quality and satisfaction targets.
  • Administers and analyzes proxy surveys and other member focused studies to incorporate relevant findings into Stars program activities.
  • Gathers member experience data and conduct analysis to identify gaps, opportunities and performance trends.
  • Partners with all appropriate business units to understand and explain trends that are driving member behavior.
  • Utilizes this information to assist senior leadership in making strategic business development decisions.
  • Tracks and reports on initiative progress at all appropriate levels of the organization; creating or joining the necessary forums to do so.
  • Provide regular timely reports on program status to leadership team.



Key Skills

  • Requires excellent written and oral communication skills.
  • Requires leadership and decision making skills.
  • Requires demonstrated aptitude for analytical thinking and ability to report findings accurately. Requires strong interpersonal, organizational and problem solving skills.
  • Ability to develop strategic plans to support company goals.
  • Requires strong project management skills. Requires strong relationship building skills to work collaboratively across departments/divisions.




  • This position has employee management responsibilities









  • Bachelor’s degree or equivalent to 4 year university degree

Preferred Education

  • Master’s degree or other advanced graduate level education






  • 3-5 years managing staff with demonstrated leadership acumen or commensurate experience
  • 5+ years professional experience working in managed care environment
  • Requires knowledge of clinical standards of care, preventive health, and Star measures.
  • Requires knowledge of health care delivery systems, distribution channels, health care industry and health insurance industry.
  • Requires knowledge of strategic planning and development.
  • Knowledge of PC's and applicable software application.
  • Knowledge of applicable laws and regulations as well as of Governmental Agencies and Regulatory.
  • Requires working knowledge of CMS Stars Program including HEDIS, CAHPS, and HOS measures

Preferred Experience

  • 7+ years professional experience in managed care environment and 2+ years as Supervisor or other role with employee management responsibility



Required Certifications

  • N/A

Preferred Certifications

  • N/A



Role Competencies









Core Competencies


Supervisor & Manager

  • Seeks input and collaboration from key internal and external stakeholders within and outside the organization
  • Actively incorporates Team Member’s input
  • Gains trust and support of Team Members on operational initiatives


Supervisor & Manager

  • The Team he/she leads, regularly meet performance targets
  • Follows though; holds Team Members accountable for performance and quality outcomes
  • Sets solid targets for operational area


Supervisor & Manager

  • Listens carefully and attentively to Team Members and conveys genuine interest
  • Makes each Team Member feel his/her contributions are important
  • Contributes to a work climate where differences are valued and supported


Supervisor & Manager

  • Acts fairly despite conflicting demands – seeks leadership assistance when unsure how to resolve
  • Presents truthful information, even if not favorable to the organization or self
  • Acts fairly despite conflicting demands – seeks leadership assistance when unsure how to resolve


Supervisor & Manager

  • Thinks about new ways to do the job better and involves Team members in thinking about new ways
  • Takes initiatives to lead the implementation of new ways to do the job
  • Helps Team Members think about different wats to work – supports new ideas from Team Members







Work Dimensions






Level Factor

Requirement (direct from leveling guide)

Work Dimension

Scope & Impact

Directs subordinates to complete assignments using established guidelines, procedures and policies

Knowledge & Skill



Follows established practices and procedures


Interacts daily with subordinates and/or functional peer groups


Generally supervises support level employees





Physical Requirements and Work Environment 

The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.


  • Activity: Sit: Continuously (more than 2/3 of the work shift)
  • Activity: Stand: Occasionally (up to 1/3 of the work shift)
  • Activity: Walk: Occasionally (up to 1/3 of the work shift)
  • Motion: Bend/Twist: Up to 1/3 of time
  • Motion: Carry/Lift: Up to 1/3 of time
  • Motion: Reach: Up to 1/3 of time
  • Motion: Squat: Up to 1/3 of time
  • Use of Hands (Left/Right): General Motor Function
  • Use of Hands (Left/Right): Precise Motor Function (Or Fine Manipulation)
  • Use of Hands: Repetitive Motion: 1/3 or more of time
  • Weight Lifted/Force Exerted: Up to 10 lbs: Up to 1/3 of time
  • Work Environment: Special visual or auditory requirements including working with a computer terminal.