HEDIS Quality Programs, Principal

About the company

The company is a mission-driven team of healthcare providers, technologists, and builders working to transform care for people with Medicaid benefits. We partner with communities to deliver technology-enabled, human-centered support that helps patients stay healthy and thrive. We’re designing tools and systems that bring care directly to those who need it most—removing barriers and reimagining what’s possible in Medicaid healthcare delivery.

Our Values

At the company, our values are the foundation of how we work, grow, and support one another:

• Bold Builders: We tackle the toughest challenges in care delivery by harnessing the power of community and technology.

• Humble Learners: We seek feedback, embrace diverse perspectives, and welcome challenges to our assumptions.

• Experiment to Improve: We use data to inform decisions and continuously assess our performance.

• Focused Urgency: Our mission drives us to act swiftly and relentlessly in pursuit of meaningful results.

If this resonates with you, we invite you to bring your creativity, energy, and curiosity to the company.

About This Role

As the HEDIS Quality Program Principal at the company, you will own the company’s approach to contractual quality performance, including HEDIS and partner-specific quality measures. You will own the end-to-end operationalization of quality measures and campaigns—from understanding the measure and identifying the opportunity, to designing and deploying high-impact programs, developing workflows, job aids and enablement, coordinating implementation, monitoring execution, and evaluating performance. Reporting to the Vice President of Care Ops, this is an opportunity to build and scale a critical component of the company’s care model, improve patient outcomes, and improve contractual performance.

Key Responsibilities

• Own the portfolio of HEDIS contractual quality measures and roadmap across the company’s partnerships.

• Translate measure specifications and partner requirements into executable programs, including building workflows and scoping and directly managing vendor partners, including for “last-mile” gap closure (eg, home lab visits, at home diagnostic kit distribution) and building the operational infrastructure to scale them.

• Conduct retrospectives, root cause analyses, and structured improvement cycles to identify execution friction points and accelerate gap closure.

• Collaborate with Care Operations and Learning and Development teams to develop and maintain the job aids, SOPs, training, and enablement needed for care teams to execute campaigns consistently.

• Coordinate supplemental data submissions and reconciliation across payer partners.

• Partner with the Analytics team to define measure logic, dashboards, patient lists, gap reporting, and automated monitoring; independently validate outputs and troubleshoot discrepancies.

• Serve as a Subject Matter Expert for the Clinical Product Development team to ensure the ideation and requirements for new automation and AI innovations reflect best practices, reduce manual work, and make HEDIS programs scalable and efficient.

• Serve as a Subject Matter Expert for the Business Development team on HEDIS metrics and targets during contract negotiations.

• Stay informed about industry trends and best practices in quality and clinical management and integrate into our operations and product design.

Minimum Qualifications

• 7+ years of experience in healthcare quality, quality operations, population health, value-based care, managed care, or a related field.

• 5+ years experience with NCQA HEDIS quality measures and performance programs, including translating requirements into implementable, scalable programs and operational workflows.

• Experience with BI and reporting tools such as Looker, Tableau, Power BI, or equivalent platforms.

• Strong program and project management skills with a proven ability to lead complex, cross-functional initiatives and manage competing priorities in a fast-paced environment.

• Comfort and demonstrated success driving program execution independently with a bias for action.

• Proven track record of managing operational vendors or clinical partners to deliver home-based services, diagnostic programs, or field campaigns.

• Excellent written and verbal communication skills, including presentation skills, for engaging with executive leadership, training frontline staff, and building strong partnerships with cross-functional teams and external stakeholders.

• Demonstrated ability to identify and manage quality program risks, develop mitigation strategies, and foster a culture of continuous improvement.

• Experience designing member outreach campaigns, care-team workflows, tasking, job aids, or training in support of quality measures.

• Ability to manage large volumes of data, analyze data, identify data gaps and develop reporting for performance management

• Must be able to work in a matrix environment

• Bachelor’s degree

Preferred Qualifications

• Experience with Medicaid managed care

• Lean Six Sigma or related quality improvement certification

• Graduate or Advanced Degree (MPH, MHA, MBA)

Hiring Range

The expected hiring range for this role is $127,000 – $159,000, depending on relevant experience, skills, and qualifications.

This is a remote role, however, candidates living in certain high-cost of living cities such as San Francisco, New York City, and Seattle, may be eligible for an additional market premium.

In addition to salary, we offer a comprehensive benefits package. Here’s what you can expect:

• Stock Options: Opportunity to invest in the company’s growth.

• Work-from-Home Stipend: A dedicated stipend for your first year to help set up your home office.

• Medical, Vision, and Dental Coverage: Comprehensive plans to keep you and your family healthy.

• Life Insurance: Basic life insurance to give you peace of mind.

• Paid Time Off: 20 vacation days, accrued over the year, plus 11 paid holidays.

• Parental Leave: 16 weeks of paid leave for birthing parents after six months of employment, and 8 weeks of bonding leave for non-birthing parents.

• Retirement Savings: Access to a 401(k) plan with a company contribution, subject to a vesting schedule.

• Commuter Benefits: Convenient options to support your commute needs.

• Professional Development Stipend: A dedicated stipend supports professional development and growth.

Offer of employment is contingent upon successful completion of a background check. Employment history and advanced degree/professional license verification (when applicable) are included as part of the standard background check process.

Don’t check off every box in the requirements listed above? Please apply anyway! Studies have shown that some of us may be less likely to apply to jobs unless we meet every single qualification. The company is dedicated to building a supportive, equal opportunity, and accessible workplace that fosters a sense of belonging – so if you’re excited about this role but your past experience doesn’t align perfectly with every preferred qualification in the job description, we encourage you to still consider submitting an application. You may be just the right candidate for this role or another one of our openings!