We are seeking a Risk & Quality Performance Manager to support enterprise-wide initiatives focused on healthcare quality improvement, risk adjustment, and regulatory performance. This role will involve analyzing healthcare data, tracking performance trends, and supporting strategic quality and risk programs. The ideal candidate will have strong data analysis skills and experience working with HEDIS, risk adjustment, or healthcare quality programs.
Key Highlights
Key Responsibilities
Technical Skills Required
Benefits & Perks
Nice to Have
Job Description
Risk & Quality Performance Manager (Remote – Healthcare Analytics)
Industry: Healthcare / Health Insurance / Quality & Risk Analytics
Work setting: Remote (US-based)
About the Role
We are seeking a Risk & Quality Performance Manager to support enterprise-wide initiatives focused on healthcare quality improvement, risk adjustment, and regulatory performance.
In this role, you will work across multiple internal teams to analyze healthcare data, track performance trends, and support strategic quality and risk programs that improve patient outcomes and ensure regulatory compliance.
You will act as a key connector between data, operations, and leadership — turning complex healthcare datasets into clear, actionable insights.
Key Responsibilities
- Lead and support risk & quality performance reporting, analytics, and forecasting
- Track and analyze healthcare quality measures (including HEDIS and CAHPS-related metrics)
- Support risk adjustment and quality data strategies, including EHR/HIE and supplemental data integration
- Monitor data quality, completeness, and accuracy across multiple sources
- Identify trends, gaps, and opportunities to improve care outcomes and performance metrics
- Partner with cross-functional teams to deliver data-driven quality improvement initiatives
- Ensure alignment with regulatory and audit requirements (CMS, NCQA, and state standards)
- Prepare reports, dashboards, and presentations for leadership and stakeholders
- Proactively identify risks, issues, and opportunities and communicate them clearly
- Manage projects from planning through execution and delivery
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What We’re Looking For
- Bachelor’s degree (or equivalent experience)
- 2+ years in healthcare analytics, risk adjustment, or quality performance management
- Experience working with HEDIS, risk adjustment, or healthcare quality programs
- Strong data analysis skills and ability to interpret complex healthcare datasets
- Experience using SQL or Azure-based data environments (or similar tools)
- Strong Excel and Microsoft Office skills
- Ability to communicate complex insights in a clear, simple way
- Experience working with cross-functional or matrixed teams
- Strong problem-solving and analytical thinking skills
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Nice to Have
- Knowledge of CMS, NCQA, or state healthcare reporting requirements
- Familiarity with healthcare data codes (CPT, LOINC, SNOMED, NDC, etc.)
- SQL proficiency
- PMP or Six Sigma certification
- Experience in large healthcare or insurance organizations
Why Apply
- Fully remote opportunity (US-based)
- High-impact role influencing healthcare quality outcomes
- Exposure to large-scale healthcare datasets and regulatory programs
- Collaborative, cross-functional environment with leadership visibility
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