Note: The job is a remote job and is open to candidates in USA. HarmonyCares is a national value-based provider of in-home primary care services for people with complex healthcare needs. The Quality Operations Manager leads national quality operations across MA Stars, MSSP MIPS APP, and ACO REACH programs by maintaining quality playbooks, educating providers and care teams, performing centralized EMR chart abstraction, resolving complex documentation issues, and supporting audit readiness and enterprise quality targets.
Responsibilities
- The Quality Operations Manager is responsible for national quality operations across HarmonyCares’ programs (MA Stars, MSSP MIPS APP, and ACO REACH). The role establishes the standard for how quality work is executed at scale by operationalizing annual measure and specification updates through enterprise playbooks and provider / care team education, executing centralized EMR chart abstraction to accelerate gap closure, and serving as the Tier 2 escalation point for complex denominator and closure documentation issues. This role drives continuous improvement by identifying recurring breakdowns and implementing workflow and training updates that reduce rework and improve performance. This position supports consistent field execution and contributes to achievement of enterprise quality targets, including 4+ Stars performance and comparable goals for MSSP MIPS APP and ACO REACH
- Maintain national quality playbooks and a shared knowledge base and keep guidance current with annual measure and specification updates and field feedback
- Drive continuous process improvement by analyzing recurring closure misses and field questions, then implementing workflow changes, job aids, and targeted education to improve closure rates and reduce rework
- Deliver provider / care team education, including new provider onboarding and ongoing continuing education, with practical “how to close” training and examples of acceptable evidence
- Align stakeholders without formal authority and drive adoption of standard work across regions
- Execute centralized EMR chart abstraction to identify qualifying evidence and document a traceable evidence trail to support closure of contracted quality gaps
- Manage the Tier 2 escalation queue for complex denominator and closure documentation issues
- Provide consistent guidance and closed-loop resolution back to Sr. Population Health Managers
- Support audit readiness by reinforcing documentation and evidence traceability standards, completing readiness checks and spot audits, and coordinating auditor-facing requests
Skills
- Bachelor's degree or equivalent combination of education/experience in quality, population health, healthcare operations, or a related field
- 4+ years of experience in MA Stars quality operations and measure execution
- Stays current on Stars, MSSP MIPS APP, and ACO Reach quality program updates and translates changes into playbooks, education, and operational guidance
- Strong working knowledge of denominator logic, closure mechanics, acceptable evidence standards, and common failure modes
- Proficient locating discrete qualifying evidence (labs, screenings, results, reports) and documenting a clear, traceable evidence trail while navigating EMR workflows at speed
- Strong PowerPoint skills for playbooks, job aids, and training and advanced Excel skills for trackers and QA logs
- Demonstrated experience developing enterprise playbooks, workflows, job aids used across multiple markets or teams
- Demonstrated experience supporting clinical and field team education, including new hire onboarding and ongoing continuing education
- Demonstrated proficiency performing medical record review and chart abstraction to identify qualifying evidence and support quality gap closure. Athena and/ or Navina experience is a plus
- Experience operating in a matrixed environment with competing priorities and time-sensitive deliverables
- Clinical credential (RN/LPN) or equivalent experience in HEDIS/Stars abstraction, coding, or health information management
- Relevant certifications such as CPHQ, Lean/Six Sigma, or PMP
- Experience supporting audit readiness activities, including evidence traceability standards and responding to payer or auditor requests
- Experience with MSSP MIPS APP and ACO REACH quality programs
Benefits
- Health, Dental, Vision, Disability & Life Insurance, and much more
- 401K Retirement Plan (with company match)
- Tuition, Professional License and Certification Reimbursement
- Paid Time Off, Holidays and Volunteer Time
- Paid Orientation and Training
- Great Place to Work Certified
Company Overview
Company H1B Sponsorship