Manager, Quality and Clinical Performance

Job Description

Job Description

Description:

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