Sr. Manager, Clinical Quality & Performance

Description

The Sr. Manager of Clinical Quality & Performance is responsible for leading and managing the organization’s clinical quality initiatives, ensuring alignment with value-based care (VBC) goals, regulatory requirements, and payer performance metrics. This role provides strategic oversight of quality improvement programs and directly supervises the Clinical Quality Coordinator. The Manager serves as the key liaison between internal clinical teams, external health plans, and executive leadership to drive measurable improvements in care delivery and outcomes.

Key Responsibilities:

• Oversee the planning, execution, and evaluation of quality improvement initiatives tied to HEDIS, Stars, ACO, CMS, and other VBC program requirements.
• Supervise the Clinical Quality Coordinator, including task delegation, performance management, and professional development.
• Lead cross-functional collaboration with clinical leaders, providers, and care teams to identify, prioritize, and close clinical care gaps.
• Review and monitor clinical documentation, data submissions, and quality reporting to ensure accuracy, compliance, and timeliness.
• Analyze performance trends using EMRs and population health tools, and present actionable insights to leadership.
• Drive internal education efforts by developing and facilitating training sessions on clinical quality metrics and documentation best practices.
• Partner with payers and regulatory bodies to ensure data submissions meet contract obligations and reporting standards.
• Serve as a subject matter expert in VBC and population health initiatives, maintaining up-to-date knowledge of relevant quality programs (e.g., NCQA, Medicare Advantage, PCMH).
• Support patient engagement initiatives related to quality goals, including outreach strategies for preventive screenings, immunizations, and wellness visits.
• Perform all other duties as assigned.

Requirements

• Certification or degree in Medical Assisting, Healthcare Administration, Public Health, Nursing, or related field.
• 5+ years of progressive experience in healthcare quality improvement, with at least 1 year in a supervisory or leadership role.
• Proven experience managing quality programs within VBC frameworks such as HEDIS, Stars, MSSP, or ACO models.
• Strong analytical skills with experience using EMRs , population health platforms, and quality dashboards. Athena experience preferred.
• Exceptional interpersonal, communication, and organizational skills.
• Demonstrated ability to lead and develop high-performing teams in a dynamic, fast-paced healthcare setting.