- Define quality metrics, error taxonomies, baselines, and targets by client, workflow, and team.
- Use quality data to identify error sources, high-risk workflows, and fixes that reduce defects at scale.
- Lead and grow a central team that audits credentialing files and processes.
- Improve audit sampling, scoring, calibration, reporting, coverage, consistency, and cost per audit.
- Translate audit findings and root causes into product, automation, workflow, and system-control changes with Product, Engineering, and Data.
- Manage daily audit throughput and turnaround time through capacity planning, work allocation, and staffing.
- Own NCQA certification readiness, evidence, survey preparation, and remediation of findings.
- Translate NCQA and client requirements into workflow updates, training, checklists, and system configuration, then verify adoption.
- Manage health plan delegation agreements, oversight schedules, and annual and ad hoc delegation audits.
- Lead corrective action plans for delegated-function findings through closure.
Quality Assurance