Program Manager II, Quality Reporting – Data Governance

🔥 0 minutes ago

☕ Washington – Remote

☕ Washington – Remote

💵 $80.9k - $125.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

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Community Health Plan of Washington

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1992

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Community Health Plan of Washington is a nonprofit health plan founded in 1992 by Washington’s community health centers that provides Medicaid (Apple Health), Medicare Advantage, Dual-eligible, and Individual & Family insurance plans across Washington state. It offers care management, behavioral health, virtual care, member support and community services, and programs such as rewards, language assistance, and provider networks to serve members and community health needs.

📋 Description

• Serve as subject matter expert and strategic partner for quality reporting, data governance, quality assurance, quality control, and regulatory reporting • Lead quality assurance and quality control processes for HEDIS, PMRR, CAHPS, QHP, HOS, and related quality measurement programs • Develop, implement, and monitor quality controls for data accuracy, regulatory compliance, audit readiness, and operational consistency • Partner with internal teams, third-party auditors, and vendors on compliance, audit readiness, and program execution • Oversee resolution of audit findings, quality concerns, and compliance risks • Improve quality assurance and quality control frameworks, including validation methodologies, quality reviews, audit protocols, issue tracking, and corrective action plans • Monitor control effectiveness and recommend risk-reduction and performance improvements • Lead validation activities assessing accuracy, completeness, consistency, and reliability of regulatory reporting and performance data • Conduct root-cause analysis of quality defects, reporting discrepancies, and audit findings • Recommend corrective and preventive actions and strengthen data governance processes • Coordinate mock audits, control testing, documentation reviews, quality monitoring, and remediation planning • Ensure readiness for NCQA, CMS, state, and external audit requirements • Monitor vendor performance, contractual compliance, and quality initiative metrics • Facilitate quality governance documentation, reporting controls, policy adherence, and communication of risks and recommendations to leadership • Develop and maintain project plans, milestones, tasks, and completion dates • Set SMART goals, allocate resources, track timelines, remove barriers, escalate risks, and propose mitigation strategies • Monitor industry trends, regulatory changes, and best practices to identify strategic opportunities • Maintain stakeholder communication and provide project status, issue, and recovery-plan updates • Establish professional relationships with key partners and keep stakeholders engaged throughout the project lifecycle

🎯 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 • 3+ years’ experience in program management, preferably related to HEDIS, CMS Star, Value Based Payment Programs, Risk Adjustment, or general healthcare • PMP, Agile Professional, or other formal project management certification preferred • Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint), including advanced Excel functionality • Experience utilizing SharePoint, Confluence, JIRA, or Smartsheet for project management, workflow tracking, documentation, issue management, operational planning, and cross-functional collaboration • Experience in program development, product development, process improvement, and evaluation strongly preferred • Working knowledge of SQL and/or Snowflake data environments, including querying and validating data, supporting reporting activities, investigating data quality issues, and partnering with analytics, engineering, and technical teams preferred • Experience with Community Health Centers, Federally Qualified Health Centers, or other healthcare systems focused on people with low income and/or barriers to equitable healthcare preferred • Knowledge of Medicaid, Medicare, and/or Exchange principles and practices, including CMS, NCQA, PQA, Milliman, and/or Acumen, with emphasis on quality improvement • Strong analytical skills and ability to interpret data, identify trends, summarize information, and communicate it concisely • Strong vendor management, objective targeting, and service level agreement monitoring skills • Knowledge and experience leveraging change management principles, practices, and methodologies • Ability to adapt to dynamic environments and manage multiple tasks and projects • Ability to work independently and collaboratively • Ability to work accurately and meet established deadlines • Strong organizational skills • Strong presentation skills for complex data, reports, and training • Successfully pass a criminal background check • Must not be sanctioned or excluded from federal or state healthcare programs

🏖️ Benefits

• 10% annual incentive target based on company, department, and individual performance goals • Medical, Prescription, Dental, and Vision • Telehealth app • Flexible Spending Accounts • Health Savings Accounts • Basic Life AD&D • Short- and Long-Term Disability • Voluntary Life, Critical Care, and Long-Term Care Insurance • 401(k) Retirement and 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 Community Service volunteer time • 10 standard holidays • 2 floating holidays • Compassion time off • Jury duty leave • Reasonable accommodation for disabilities