Job Description

Who we are

Community Health Plan of Washington is

an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work.
• Reduce health disparities.
• Create an equitable work environment.

About the Role

The Program Manager II, Quality Reporting & Data Governance serves as the subject matter expert and strategic partner supporting quality reporting, data governance, quality assurance, quality control, and regulatory reporting activities for Healthcare Effectiveness Data Information Set (HEDIS), Consumer Assessment of Healthcare Providers (CAHPS), Qualified Health Plan (QHP), and Health Outcomes Survey (HOS), and related quality programs. This role leads governance activities that promote accuracy, integrity, compliance and audit readiness of quality reporting deliverables and regulatory submissions. This position facilitates quality assurance and quality control processes, identifies operational risks, recommends corrective actions and supports continuous improvement initiatives designed to improve measure performance and adherence to NCQA, CMS, state and organizational quality standards. The Program Manager II develops and manages project plans, facilitates timely and accurate submissions, and removes barriers to execution, and collaborates cross-functionally with various departments to develop sustainable processes that drive quality excellence, successful audit outcomes, and advance organizational strategic goals.

To be successful in this role, you:

• Bachelor’s degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or other 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 (required).
• 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 to support project management, workflow tracking, documentation, issue management, operational planning, and cross-functional collaboration (required).
• Experience in program development, product development, process improvement, and evaluation is strongly preferred.
• Working knowledge of SQL and/or Snowflake data environments, including the ability to query and validate data, support reporting activities, investigate data quality issues, and partner effectively with analytics, engineering and technical teams (preferred).
• Have experience with Community Health Centers (CHC), Federally Qualified Health Centers (FQHC), or other healthcare systems focused on those with low income and/or barriers to equitable healthcare (preferred).

Essential Functions and Roles and Responsibilities:

• Lead quality assurance and quality control processes supporting HEDIS, Prospective Medical Record Review (PMRR), CAHPS (Medicaid & Medicare), QHP, HOS and related quality measurement programs. Develop, implement and monitor quality controls that ensure data accuracy, regulatory compliance, audit readiness, and operational consistency across all quality activities. Partner with internal teams, third-party auditors, and vendors to ensure compliance, audit readiness, and successful program execution. Oversee resolution of audit findings, quality concerns and compliance risks.
• Support the development, implementation, and continuous improvement of quality assurance and quality control frameworks, including validation methodologies, quality reviews, audit protocols, issue tracking, and corrective action plan processes. Monitor effectiveness of controls and provide recommendations to reduce risk and improve performance.
• Lead quality validation activities to evaluate the accuracy, completeness, consistency, and reliability of regulatory reporting and performance measurement data. Conduct root-cause analysis of quality defects, reporting discrepancies, and audit findings. Partner with internal stakeholders and vendors to recommend corrective and preventive actions and strengthen data governance processes.
• Coordinate audit readiness strategies, including mock audits, control testing, documentation reviews, quality monitoring activities, and remediation planning. Ensure organizational preparedness for NCQA, CMS, state, and external audit requirements.
• Monitor vendor performance supporting HEDIS, CAHPS, HOS, PMRR, and other quality initiatives. Review performance metrics, assess compliance with contractual obligations, and provide recommendations for improvement strategies when performance gaps are identified.
• Facilitate quality governance activities by supporting documentation standards, maintaining reporting controls, monitoring adherence to established policies and procedures, and communicating quality-related risks, findings and recommendations to leadership.
• Develop and maintain detailed project plans including milestones, tasks, and target/actual dates of completion. Set SMART goals, allocate resources effectively, and ensure timely execution. Track team adherence to project timelines and clear barriers to team progress, including team conflict. Escalate risks and propose mitigation strategies to leadership.
• Develop program knowledge to support key strategic opportunities and improvement strategies. Stay informed about industry trends, regulatory changes, and best practices. Use this knowledge to identify strategic opportunities and develop improvement strategies that align with organizational goals.
• Maintain effective communication with stakeholders, ensuring regular updates on project status, issues, and recovery plans. Establish and nurture professional relationships with key partners to facilitate collaboration and support. Ensure all stakeholders are informed and engaged throughout the project lifecycle.

Knowledge, Skills, and Abilities:

• Knowledge of Medicaid, Medicare and/or Exchange principles and practices pertaining to any of the following: Centers for Medicaid and Medicare (CMS), National Committee for Quality Assurance (NCQA), Pharmacy Quality Alliance (PQA), Milliman and/or Acumen with emphasis in quality improvement.
• Strong analytical skills and ability to interpret data identify key trends, summarize, and communicate information in a concise and understandable manner.
• Strong vendor management, objective targeting, and service level agreement monitoring.
• Knowledge of and experience leveraging change management principles, practices, and methodologies.
• Skilled in adapting to dynamic environments and juggling multiple tasks and projects to meet operational demands driven by business needs.
• Ability to work both independently without supervision and collaboratively as part of a team.
• Ability to work with a high degree of accuracy and meet established deadlines.
• Maintain strong organizational skills to ensure efficient and effective operations.
• Strong skills in presenting complex data, reports, and training to groups.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is (66) (see full range below) and has a (10%) annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

• 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
• Time off including 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

Sensory/Physical/Mental Requirements:

Sensory*:

Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking, and possibly standing

Mental:

Frequent decision-making.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.