Job Details

Director of Quality (Health Plan) - Remote
Position Overview

We are seeking an experienced and strategic Director of Quality to lead enterprise-wide quality improvement initiatives within a health plan environment. This role is responsible for driving exceptional performance across major quality programs including:

• CMS Medicare Advantage Star Ratings
• NCQA Ratings & Accreditation
• Exchange QRS Ratings
• Medicaid Quality Programs
• HEDIS and Supplemental Data Measures

The Director of Quality will design and execute quality strategies, close clinical care gaps, and integrate quality improvement into value-based contracting models to improve both clinical outcomes and member experience.
Key Responsibilities
Quality Strategy & Program Leadership

• Develop and implement overarching quality strategies to achieve superior health plan ratings and accreditation performance.
• Lead cross-functional efforts to optimize clinical quality and member experience outcomes.

Quality Improvement & Operational Execution

• Design ROI-driven quality improvement programs with measurable feedback loops.
• Drive operational processes to meet strategic quality imperatives.

HEDIS & Supplemental Data Performance

• Oversee HEDIS performance improvement and supplemental data strategy.
• Ensure readiness for audits and strong outcomes in MA Stars and HEDIS measures.

Resource & Budget Management

• Prioritize departmental resources effectively while balancing multiple organizational priorities.
• Support capital budgeting decisions related to quality initiatives.

Data Analytics & Reporting

• Partner with clinical quality analytics teams to interpret data and develop targeted interventions.
• Oversee quality performance reporting and measure tracking.

Required Qualifications

• Bachelor's Degree in healthcare, business, or related field (Master's preferred: MPH, MHA, MBA).
• Minimum 7 years of management/supervisory experience in a health plan environment .
• At least 5 years of quality improvement program leadership , with strong emphasis on Medicare Advantage Star Ratings .
• Minimum 3 years of experience with HEDIS audits and supplemental data strategies.
• Expertise in quality methodologies such as:
  
  • Six Sigma
  • Lean
  • Root Cause Analysis
  • PDSA Cycles

Preferred Qualifications

• Certified Professional in Healthcare Quality (CPHQ) highly preferred.
• Strong background in regulatory requirements and accreditation readiness.
• Proven ability to lead matrixed teams and enterprise-wide initiatives.

Skills & Competencies

• Strategic leadership and program development expertise
• Strong project and stakeholder management
• Data-driven decision-making