Manager Quality Analytics (Strategic Initiatives)

Manager Quality Analytics (Strategic Initiatives)

Join Us - Where Your Talent Meets Opportunity. We're Better Together. The team you'll join is a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity : We are hoping you will join us as a Manager Quality Analytics (Strategic Initiatives) and help shape the future of healthcare where you'll be an integral part of our Quality Analytics team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. As the Manager of Quality Analytics (Strategic Initiatives) you will be responsible for the development, implementation and evaluation of initiatives to improve health outcomes and performance measures pertinent to member care at CalOptima Health. You will provide guidance to assigned staff and oversee process development in support of health management and quality improvement initiatives. You will collaborate with the Director to develop and implement strategies which support improvement goals and care gap closure including, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS) activities, National Committee for Quality Assurance (NCQA) requirements, Managed Care Accountability Sets (MCAS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and Centers for Medicare & Medicaid (CMS) Star Rating measures. You will communicate the plan and health network performance to stakeholders, including health networks, provider and member stakeholder groups and quality leadership, including the Quality Improvement Health Equity Committee (QIHEC) and Board of Directors Quality Assurance Committee. You will lead a cross-departmental team of professional staff in the development of performance measurement reports, the review of data to identify and report issues and trends and to escalate underperforming entities to stakeholders. Together, we are building a stronger, more equitable health system.

Your Contributions To The Team :

• 50% - Program Leadership : Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals / priorities for the department. Hires, manages, trains, reviews and sets goals for the team. Collaborates with the Director to develop and implement strategic initiatives which support care gap closure and rate improvement including, but not limited to, HEDIS activities, NCQA requirements, Managed Care Accountability Sets (MCAS), CAHPS and CMS Star measures. Leads cross-functional and inter-departmental teams to develop best practices and generate ideas for improvement related to health plan ratings for both Medi-Cal and Medicare lines of business.
• 45% - Program Support : Develops processes and communicates needs for quality improvement and corrective action plans to health networks, as needed. Reports and escalates any health networks failure to comply with required improvement plans, or significantly improved performance to the Audit and Oversight Committee. Participates actively in QIHEC and subcommittees regarding quality improvement and member experience. Participates in audits conducted by regulatory and accreditation agencies regarding plan and health network level quality performance, tracking and trending. Develops, reviews and revises policies and procedures for member experience or other policies as assigned, consistent with, but not limited to, regulatory requirements and NCQA guidelines on an annual basis. Ensures timely and accurate submission of reports to regulatory agencies. Supports the Director in developing an annual budget for the department and manages department budget dollars related to required surveys and member experience improvement initiatives costs.
• 5% - Other : Completes other projects and duties as assigned.

Do You Have What the Role Requires? Bachelor's degree in healthcare, healthcare informatics or related field PLUS 5 years of experience in a managed health care organization working with the NCQA, CMS, Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) or other quality performance standards, metrics and regulatory requirements required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

You'll Stand Out More If You Possess the Following : Master's degree in public health, healthcare or related field. 2 years of supervisory experience. Certified Health Education Specialist.

What the Regulatory Agencies Need You to Possess? n / a.

Your Knowledge & Abilities To Bring to This Role : Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees / coalitions. Utilize computer and appropriate software (e.g., Microsoft Office : Word, Outlook, Excel, PowerPoint) and job specific applications / systems to produce correspondence, charts, spreadsheets, and / or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations) : Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and / or equipment less than 10 pounds

Ways We Are Here For You : You'll enjoy competitive compensation for this role. Our current hiring range is : Pay Grade : 314 - $99,902 - $159,843 ($48.03 - $76.8476). The base pay offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors. This position is approved for Partial Telework (

Our Work Environment : If located at the 500, 505 Building or a remote work location : Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE : Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community : Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud.

Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impact on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is October 16, 2025 at 9 : 00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and / or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal