What are the responsibilities and job description for the Quality Improvement Manager position at Champion Health Plan is a Medicare Advantage...?
Job Summary
Champion Health Plan is seeking a Quality Improvement Manager to support our Medicare Advantage Prescription Drug (MAPD) Quality Improvement Program.
This role focuses on improving performance across STAR Ratings, HEDIS, CAHPS, and Risk Adjustment (RAF) initiatives while ensuring compliance with CMS, NCQA, and state regulatory requirements. The position works closely with clinical and operational teams, providers, and vendors to support quality outcomes, member experience, and audit readiness.
This is an on-site role in Long Beach, CA.
Duties
- Support day-to-day Quality Improvement activities related to STAR Ratings, HEDIS, CAHPS, and RAF
- Analyze performance data to identify trends, gaps, and improvement opportunities
- Participate in annual HEDIS medical record review activities, including vendor coordination and data validation
- Collaborate with clinical teams, Claims, UM, IT, and Provider Relations to address documentation and encounter data issues
- Support documentation improvement efforts using CPT and ICD-9/ICD-10 coding concepts related to quality and risk adjustment
- Develop and track performance improvement and corrective action plans
- Prepare reports, dashboards, and presentations for Quality leadership and committees
- Support execution of the CMS-required Quality Improvement Work Plan
- Develop training materials and conduct educational sessions related to quality and performance initiatives
- Participate in cross-functional meetings and ongoing audit readiness efforts
Required Qualifications
- Bachelor’s degree required
- Minimum 2 years of experience in Quality Improvement, managed care, or a healthcare/insurance environment
- Minimum 2 years of leadership or supervisory experience
- Knowledge of CMS quality programs (HEDIS, STAR Ratings, CAHPS)
- Familiarity with healthcare documentation and coding concepts (CPT, ICD-9/ICD-10)
- Strong analytical skills with the ability to translate data into actionable insights
- Excellent communication skills, including staff training and cross-functional collaboration
- Proficiency in Microsoft Office (Excel, Word, PowerPoint)
- Ability to work on-site in Long Beach, CA
Preferred Qualifications
- Medicare Advantage experience in a health plan or managed care organization
- Experience supporting PIPs, CCIPs, or CMS quality initiatives
- Coding certification (CPC, CRC, or RMC) and/or CPHQ
- Master’s degree in Healthcare Administration, Nursing, Public Health, or related field
- Experience supporting CMS audits or NCQA surveys
Pay: From $85,046.04 per year
Benefits:
- 401(k)
- AD&D insurance
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $85,046