Job Description

Upward Health is a home-based medical group specializing in primary medical and behavioral care for individuals with complex needs. We deliver care directly in the community, reducing barriers such as long delays due to scheduling or lengthy commutes to a provider’s office. Beyond medical supports, we also assist our patients with challenges that may affect their health, such as food insecurity, social isolation, housing needs, and transportation.

Why Is This Role Critical?

The Quality Program Manager is responsible for supporting and managing quality outcomes and quality performance improvement activities across Upward Health. This role combines elements of both quality management and clinical compliance to ensure high-quality care delivery. This role analyzes corporate and market data, identifies trends, determines root cause issues, develops work plans, and organizes cross-functional teams to achieve quality goals. This position leads efforts to optimize the quality-of-care delivery and care coordination in a manner consistent with Upward Health’s clinical model. The Quality Program Manager closely collaborates with leadership throughout the organization, at the corporate and local level, to optimize consistency in operationalizing the clinical model to drive optimal quality outcomes.

Key Responsibilities:

· Quality Improvement Initiatives: Coordinate and lead the Quality Improvement Program (QIP). Identify opportunities for improvement and implement action plans to address gaps. Oversee the Quality Management Committee.

· Data Analysis and Reporting: Synthesize health plan data for internal consumption and monitoring. Monitor client quality measures against targets and drive performance.

· Project Management: Manage multiple projects simultaneously, ensuring timely completion and alignment with organizational goals. Assist the local quality task force teams with timeline and outcome management for proper status report outs.

· Compliance and Regulatory Oversight: Participates in the Compliance Committee to ensure compliance with federal, state, and payer regulations, including NCQA standards. Assist with survey readiness and maintaining accreditation and certification.

· Interdepartmental Collaboration: Work with multidisciplinary teams to address quality and safety issues, develop and revise policies and procedures, and support clinical staff in quality improvement efforts.

· Training and Education: Collaborate with appropriate team members to develop and deliver training and education related to quality management improvement enhancements.

Required Skills and Competencies:

· Extensive experience in quality improvement within a healthcare setting.

· Experience in population health management (HEDIS, Stars Rating).

· Working knowledge of CMS requirements for an integrated medical home and primary care (Medicare, Medicaid).

· Working knowledge of payer and provider, specifically for Patient Center Medical Home (PCMH), NCQA standards.