Quality Manager (Medical Assistant)
Job Description
ABOUT ADOBE
Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 with a mission of positively impacting the lives we touch. Headquartered in Phoenix, AZ, with satellite locations across multiple states, APH fosters a culture rooted in inclusivity, human kindness, and high-quality care.
Recognized by Inc. 5000 as one of America’s Fastest-Growing Private Companies and honored for a fifth consecutive year as a “Best Place to Work” by the Phoenix Business Journal, APH continues to expand its reach and impact.
APH partners with health plans, providers, hospitals, and families to deliver tailored programs including case management, in-home and in-clinic wellness assessments, preventative care, transitional care, and social services. As one of the nation’s few fully integrated healthcare organizations, APH delivers comprehensive, coordinated medical and social support through a wide range of specialized service lines.
With continued growth on the horizon, APH is seeking mission-driven individuals who are passionate about improving health outcomes and supporting those in need.
POSITION PURPOSE
The Quality Manager is responsible for leading the development, implementation, and execution of quality improvement strategies designed to improve HEDIS performance, Medicare Stars outcomes, regulatory compliance, clinical quality, and member outcomes. This role provides strategic and operational leadership to quality initiatives, translating performance data into actionable interventions that drive measurable improvement across providers, care teams, and members.
The Quality Manager partners closely with Population Health, Clinical Operations, Provider Relations, Care Management, Member Engagement, Analytics, Compliance, and health plan partners to identify performance gaps, develop targeted interventions, monitor outcomes, and reduce variation in care delivery.
In this role, you will be responsible for traveling throughout the APH-supported states including, but not limited to, AZ, LA, NV, NM, and OR.
DUTIES & RESPONSIBILITIES
- Lead the development and execution of annual HEDIS and quality improvement strategies aligned with organizational and health plan priorities.
- Monitor HEDIS, Medicare Stars, quality, utilization, and other performance indicators to identify opportunities for improvement.
- Translate quality data into actionable strategies, workflows, and interventions.
- Develop and maintain quality improvement plans addressing performance gaps and opportunities.
- Ensure quality initiatives are aligned with applicable CMS, NCQA, health plan, and regulatory requirements.
- Identify trends and root causes contributing to quality gaps and develop sustainable solutions.
- Partner with Analytics to develop, validate, and monitor quality dashboards, reports, KPIs, and performance metrics.
- Establish performance targets and regularly evaluate progress toward organizational and health plan goals.
- Segment and prioritize members, providers, and populations based on identified quality gaps and opportunities.
- Monitor intervention effectiveness and adjust strategies based on performance and outcomes.
- Use data to identify workflow breakdowns, variation in care, and opportunities to improve provider and member outcomes.
- Oversee operational execution of HEDIS and quality improvement initiatives, including outreach, care gap closure, medical record retrieval, documentation improvement, and supplemental data processes as applicable.
- Develop standardized workflows and processes that support timely and accurate closure of quality gaps.
- Partner with clinical teams to ensure interventions are actionable, measurable, and integrated into existing workflows.
- Identify barriers to quality performance and lead process improvement initiatives to address them.
- Support readiness activities for HEDIS audits, regulatory reviews, and health plan quality initiatives.
- Partner with Provider Relations and clinical leadership to communicate quality performance and develop provider-specific improvement strategies.
- Translate HEDIS and quality requirements into practical provider workflows and actionable opportunities.
- Facilitate provider education related to HEDIS measures, documentation, coding, preventive care, and quality improvement.
- Develop provider performance feedback mechanisms and identify opportunities for targeted intervention.
- Evaluate provider engagement based on measurable changes in behavior and outcomes rather than participation alone.
- Collaborate with Care Management, Member Engagement, and clinical teams to develop targeted outreach strategies.
- Support campaigns addressing preventive screenings, chronic condition management, medication adherence, transitions of care, and other quality opportunities.
- Evaluate outreach effectiveness through contact rates, scheduling, completion, gap closure, and clinical outcomes.
- Develop escalation and follow-up processes for members who are unable to be reached or require additional intervention.
- Lead, coach, and develop quality/HEDIS team members, establishing clear expectations, accountability, and performance standards.
- Establish team KPIs and routinely monitor productivity, quality, timeliness, and outcomes.
- Promote a culture of accountability, collaboration, continuous improvement, and data-driven decision-making.
- Identify development opportunities and build staff capability in HEDIS, Stars, quality improvement, analytics, and population health.
- Manage competing priorities while maintaining focus on organizational quality goals and deadlines.
- Serve as a subject matter expert for HEDIS, quality improvement, and population health initiatives.
- Partner with senior leadership to translate organizational priorities into measurable quality strategies.
- Collaborate across departments to align workflows, resources, technology, and operational priorities.
- Work directly with health plan partners to understand performance expectations, identify gaps, and develop action plans.
- Lead cross-functional quality improvement initiatives and communicate progress, barriers, and outcomes to leadership.
SKILLS & QUALIFICATIONS
- Minimum of three (3) years of leadership or management experience.
- Minimum of three (3) years of experience in healthcare quality, HEDIS, population health, value-based care, or related healthcare operations.
- Experience interpreting healthcare performance data and translating findings into actionable improvement strategies.
- Strong understanding of CMS, NCQA, Medicare Advantage, and value-based care environments.
- Demonstrated ability to lead cross-functional initiatives and drive measurable outcomes.
- Strong communication, presentation, project management, and organizational skills.
- Ability to work flexible hours, including evenings and weekends, as needed.
- Experience with Medicare Advantage, Medicaid, and/or Marketplace populations.
- Experience with provider performance management and value-based care.
- Experience with risk adjustment, RAF, utilization management, MLR, or related performance programs.
- Experience with HEDIS medical record review, hybrid measures, supplemental data, and audit processes.
- Experience with quality reporting platforms, CRM systems, healthcare analytics, and/or population health technology.
- Certified Professional in Healthcare Quality (CPHQ), Certified HEDIS Compliance Auditor (CHCA), or related certification.
- Experience developing dashboards, KPIs, and performance management frameworks.
- Knowledge of health care claim elements: Current Procedural Terminology (CPT), CPT Category II (CPTII), Healthcare Common Procedure Coding System (HCPS), National Drug Code (NDC), National Provider Identifiers (NPIs), and Taxpayer Identification Numbers (TINs)
EDUCATION, LICENSES, & CERTIFICATIONS
- Associate degree required.
- Bachelor degree preferred.
- Medical Assistant degree required.
- Certified Medical Assistant or Registered Medical Assistant preferred.
- Basic Life Support (BLS) certification.
BENEFITS & TOTAL REWARDS
- Paid Orientation and Training
- Insurance – Medical, Dental, Vision, and Life
- 401k Plan – 3% match
- Employee Assistance Program
- Tuition Reimbursement
- Continued Education Support
- Mileage Reimbursement (if applicable)
- Referral Bonuses
- Paid Holidays (8 days)
- Paid Time Off (20 days)
- Paid Volunteer Hours
CHARACTER & COMPETENCIES
- Courage – To have the courage to the right thing at the right time.
- Ownership – To take ownership of every issue you touch.
- Respect – To respect yourself, co-workers, and for those whom you care.
- Excellence – To be excellent in all that you do.
- Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
- Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.
- Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
- Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
- Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
- Problem-Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
- Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
- Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
PHYSICAL DEMANDS & WORK ENVIRONMENT
- Frequently required to drive for extended periods.
- Regularly required to travel throughout the state and between states.
- Occasionally required to travel with overnight and multiple day accommodations.
- Occasionally required to stand.
- Occasionally required to walk.
- Continually required to sit.
- Continually required to travel in a vehicle in various temperatures.
- Occasionally required to climb, balance, bend, stoop, kneel or crawl.
- Continually required to talk or hear.
- While performing the duties of this job, the noise level in the work environment is usually moderate.
- May occasionally lift and /or move more than 30 pounds.
- Must be able to physically perform the essential duties of the position which include lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, use of hands, balancing, walking, standing, talking, hearing, and typing.
EQUAL EMPLOYMENT OPPORTUNITY
APH is an Equal Opportunity Employer where all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.