Job description
Manager Quality Analytics, Quality Incentive Programs
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Manager Quality Analytics, Quality Incentive Programs and help shape the future of healthcare where you'll be an integral part of our Quality Analytics team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Manager of Quality Analytics (Quality Incentive Programs) will be responsible for leading the development, implementation and evaluation of CalOptima Health's provider, health network and hospital quality incentive initiatives, including pay-for-value (P4V) models. You will provide strategic guidance to assigned staff and oversee the design, implementation and optimization of incentive programs. You will integrate quality analytics, provider performance strategy and incentive program development with effective team leadership to drive measurable improvements across Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA), Managed Care Accountability Sets (MCAS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Centers for Medicare & Medicaid (CMS) Star Rating measures. You will communicate plan and health network-level performance to key stakeholders, health networks, provider groups and quality leadership, such as the Quality Improvement Health Equity Committee (QIHEC). Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 50% - Program Leadership
- Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
- Directs and assists the team in carrying out departmental responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
- Manages staff and is responsible for selection, training, coaching, development, performance evaluation and establishing individual performance goals.
- Collaborates with the Director to develop incentive methodologies, performance thresholds, tier structures, measures and payment strategies that align provider and hospital incentives with organizational quality priorities.
- Ensures incentive programs are aligned with applicable CMS, Department of Health Care Services (DHCS), NCQA, contractual, regulatory and organizational requirements.
- Represents Quality Analytics department in internal committees and in meetings with providers, health networks and hospital partners, participating both virtually and in person, including after hours as needed.
- Develops, reviews and revises policies and procedures, consistent with regulatory requirements and NCQA guidelines on an annual basis.
- Participates in regulatory and industry pay‑for‑value and incentive committees and collaborative meetings.
- 45% - Program Oversight
- Evaluates program effectiveness, provider, health network and hospital participation, performance trends and return on investment; recommends modifications based on results.
- Develops structured processes and effectively communicates quality improvement needs and corrective action requirements to health networks, ensuring clarity, alignment and timely follow‑through.
- Oversees the development and maintenance of dashboards, scorecards, provider reports, incentive calculations and other analytical tools.
- Reports and escalates any health network's failure to comply with required improvement plans or significantly improved performance to the Audit and Oversight Committee.
- Develops hospital, health network and provider-facing materials that clearly explain quality measures, performance expectations, incentive opportunities and results.
- Partners with internal teams and external vendors to validate data feeds, payment summaries, and measure‑level completion data that drives automated payout cycles.
- Partners with the CalOptima Health Grants Management team to design, implement and evaluate quality improvement grant programs that strategically reinvest unearned pay‑for‑value dollars to advance organizational quality goals.
- 5% - Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Bachelor's degree in health care, health care administration, public health, health care informatics or related field PLUS 5 years of experience in quality improvement projects, provider engagement or value-based payment initiatives required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- 3 years of progressive leadership experience, including direct supervision of staff required.
You'll Stand Out More If You Possess the Following:
- Master's degree in public health, health care or related field.
What the Regulatory Agencies Need You to Possess?
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 314 - $99,902 - $159,843 ($48.03 - $76.8476).
- The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)
- A https://www.caloptima.org/en/careers#benefits
- CalPERS pension program and additional retirement packages.
- Additional benefits and perks including:
- A generous PTO program
- A quality work life balance
- Various wellness programs
- Tuition Reimbursement
- Professional development opportunities
- Career development opportunities
- Flexible scheduling
- And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.
Our Work Environment:
If located at the 500, 505 Building or a remote work location:
- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- There are no harmful environmental conditions present for this job.
- The noise level in this work environment is usually moderate.
If located at PACE:
- Work is typically indoors in a clinical setting serving the frail and elderly.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
If located in the Community:
- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- Employee will occasionally work outdoors in varied temperatures.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
Why Join Us?
We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.
What's Your Next Step?
All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is November 25, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
Our Commitment to You
Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://apptrkr.com/9967540
je-f2d5ab217a4f4b01be1e6c73c1c2ebcb
