OUR PHILOSOPHY 

Blue Zones Health is creating a Well-Being Services Organization that extends healthcare beyond the clinical encounter. Traditional quality programs often identify gaps after the fact — a screening was missed, a test was not completed, a chronic condition was not adequately monitored, or required evidence was not captured. We want quality intelligence to become actionable before the opportunity is lost. 

For every member, the organization should be able to understand what preventive and evidence-based care they are due for, what gaps currently exist, what can be addressed during the next clinical encounter, and what requires follow-up outside the clinic. The Quality function creates and maintains that intelligence. 

Quality works as part of a broader clinical learning system. Clinical Documentation & Intelligence helps providers understand the member's clinical picture. Quality identifies evidence-based care that is due or missing. Clinical Management establishes pathways and intervention triggers. Providers make clinical decisions. Care Management, Care Coordination, and Well-Being Services help members complete the recommended care. The goal is not simply better quality scores — it is to help members receive the right preventive and clinical care at the right time. 

POSITION SUMMARY 

Blue Zones Health is building a different kind of healthcare organization — one that combines excellent clinical care with lifestyle medicine, prevention, well-being, and community to help people live longer, healthier lives. 

The Quality Manager, Clinical Performance leads the operational quality function within the Well-Being Services Organization — responsible for HEDIS, Stars, clinical quality measures, care-gap identification and closure, quality performance monitoring, and provider quality enablement. At Blue Zones Health, quality is not simply a reporting or compliance function; quality information should tell us what care a member needs, what may be missing, and where there is an opportunity to intervene earlier. 

The Quality Manager translates health plan and regulatory quality requirements into practical workflows for providers, Clinical Operations, Clinical Documentation & Intelligence, Clinical Management, Care Management, and Well-Being Services, ensuring care gaps are accurately identified, surfaced at the right time, acted upon by the appropriate care team, and closed with appropriate evidence. 

Working closely with the VP of Well-Being Services, Medical Directors, Clinical Documentation & Intelligence, Coding, Clinical Management, providers, health plans, and technology teams, the Quality Manager helps make quality an integrated part of how Blue Zones Health delivers care rather than a retrospective measurement exercise. 

KEY RESPONSIBILITIES 

1.  Clinical Quality Strategy & Performance 

• Lead operational execution of Blue Zones Health's clinical quality strategy across health plan partnerships, providers, and member populations 
• Translate HEDIS, Stars, CMS, health plan, and organizational quality requirements into measurable priorities and actionable clinical workflows 
• Establish performance goals, operating rhythms, dashboards, and accountability mechanisms for quality measures 
• Identify areas of underperformance and develop targeted improvement strategies in partnership with clinical and operational leaders 
• Maintain a clear line of sight between quality initiatives, member outcomes, provider performance, and organizational goals 

2.  HEDIS, Stars & Quality Measure Management 

• Serve as the operational subject-matter expert for applicable HEDIS, Stars, and health plan quality measures 
• Maintain measure specifications, eligibility criteria, exclusions, numerator and denominator logic, evidence requirements, and performance targets 
• Monitor measure performance throughout the year rather than relying primarily on retrospective year-end gap closure 
• Identify measure-specific barriers and implement improvement plans 
• Partner with health plans to reconcile quality data, measure performance, supplemental data, and identified gaps 
• Ensure operational teams understand what is required to successfully address and document applicable quality measures 

3.  Care Gap Identification & Closure 

• Build and oversee processes for identifying, prioritizing, tracking, and closing member-level care gaps 
• Establish workflows that clearly identify which gaps can be addressed by PCPs, which require specialists or external services, and which can be supported through Well-Being Services or Care Management 
• Ensure care gaps are surfaced at the appropriate point in the member journey, including before relevant provider encounters whenever possible 
• Monitor gap-closure activity and identify barriers preventing members from completing recommended care 
• Establish closed-loop processes to verify that completed services are documented and appropriately reflected in quality reporting 

4.  Pre-Visit Quality Intelligence 

• Partner with the Director of Clinical Documentation & Intelligence to integrate quality information into a unified pre-visit clinical view for providers 
• Ensure upcoming encounters surface relevant preventive, chronic-care, and quality opportunities alongside other clinically important information 
• Prioritize information so providers receive actionable intelligence rather than multiple disconnected lists and alerts 
• Monitor whether quality opportunities surfaced before visits are addressed and use results to improve pre-visit workflows 
• Partner with Product and technology teams to automate and scale quality intelligence wherever appropriate 

5.  Provider Quality Enablement 

• Translate quality measures into practical guidance that providers and practice teams can easily understand and act upon 
• Develop provider-facing education, tools, reports, and feedback that support improved quality performance 
• Identify provider-specific patterns and opportunities and partner with Provider Success and clinical leadership on targeted improvement efforts 
• Help practices incorporate care-gap closure into routine workflows rather than treating quality as a separate periodic initiative 
• Support provider onboarding and ongoing education related to BZH quality expectations and clinical quality performance 

6.  Well-Being Services & Care Management Integration 

• Partner with Care Management, Care Coordination, and Well-Being Services to identify quality gaps that can be supported through member outreach, education, scheduling, lifestyle interventions, or community resources 
• Establish clear handoffs so member-facing teams understand which gaps require action and what support they can appropriately provide 
• Identify barriers such as transportation, social isolation, health literacy, access, or member engagement that may prevent completion of recommended care 
• Use WBS capabilities to address underlying barriers while maintaining appropriate boundaries between member engagement and clinical decision-making 
• Measure whether WBS-supported interventions contribute to successful completion of recommended care 

7.  Clinical Documentation & Coding Partnership 

• Partner with the Director of Clinical Documentation & Intelligence to ensure documentation requirements associated with quality measures are incorporated appropriately into provider education and clinical workflows 
• Work with Coding Operations to identify documentation or data-capture deficiencies that prevent completed care from being accurately recognized 
• Distinguish between true clinical care gaps and documentation/data gaps so resources are directed appropriately 
• Use recurring findings to improve provider education, pre-visit planning, and operational workflows 
• Maintain clear separation between quality-measure management, clinical documentation integrity, and coding determinations 

8.  Quality Data, Reporting & Improvement 

• Establish dashboards and reporting that provide timely visibility into quality performance by measure, health plan, provider, population, and market 
• Validate quality data and investigate discrepancies among health plan data, clinical records, claims, and internal systems 
• Identify populations and providers with the greatest opportunities for improvement and prioritize interventions accordingly 
• Analyze performance trends to understand why gaps remain open and whether interventions are producing results 
• Provide the VP, Well-Being Services and other leaders with actionable quality insights and recommendations rather than reporting data alone 

9.  Cross-Functional Leadership & Continuous Improvement 

• Work closely with the VP, Well-Being Services, Medical Directors, Clinical Documentation & Intelligence, Coding, Clinical Management, Care Management, Provider Success, Product, and participating providers 
• Establish clear ownership, workflows, and escalation paths for quality opportunities that cross organizational boundaries 
• Build repeatable processes that allow the Quality function to scale as membership, provider networks, and health plan relationships grow 
• Foster a culture in which quality is understood as part of everyday care delivery and member experience rather than a year-end score 

Budgeted Compensation: $115,000-$145,000

REQUIRED QUALIFICATIONS

• Bachelor's degree in nursing, healthcare administration, public health, health information management, or a related healthcare field 
• Significant experience in clinical quality, HEDIS, Stars, population health, value-based care, or health plan quality operations 
• Strong working knowledge of HEDIS measure specifications, Medicare Stars, CMS quality requirements, and clinical quality measurement 
• Experience managing care-gap identification and closure programs 
• Demonstrated ability to translate measure specifications into operational workflows 
• Experience working with provider practices and clinical teams to improve quality performance 
• Strong understanding of preventive care, chronic disease management, and population health 
• Strong analytical skills and experience working with clinical, claims, quality, and health plan data 
• Demonstrated ability to identify root causes of performance gaps and implement measurable improvement strategies 
• Strong project-management, communication, and cross-functional leadership skills 

PREFERRED QUALIFICATIONS 

• RN, LPN/LVN, RHIA, RHIT, CPHQ, or other relevant clinical or quality credential 
• Certified Professional in Healthcare Quality (CPHQ) 
• Medicare Advantage experience 
• Experience working within an IPA, risk-bearing medical group, ACO, or delegated entity 
• Experience with NCQA requirements and health plan quality audits 
• Experience with supplemental data, medical-record review, and quality-data reconciliation 
• Experience designing technology-enabled care-gap and pre-visit workflows 
• Experience with lifestyle medicine, preventive care, or whole-person care models