Director of Quality and Continuous Improvement, Member Care
New
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Sidecar HealthHealth Insurance
RemoteFull-TimeDirector
SalaryCompetitive salary, bonus opportunity, and equity package
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Job Details
- Experience
- 8-10 years of progressive experience in process excellence, quality management, or operational improvement, with 3-5 years in leadership roles.
- Required Skills
- Artificial IntelligenceQuality AssuranceProcess improvementHIPAA
Requirements
- 8-10 years of progressive experience in process excellence, quality management, or operational improvement.
- 3-5 years in leadership roles.
- Bachelor’s degree in business administration, Operations Management, Healthcare Administration, or related field.
- Demonstrated application of methodology in a contact center or healthcare services environment.
- Direct experience with quality monitoring, scorecards, contact center analytics, and coaching leaders.
- Hands-on experience directing or implementing AI-powered quality tools, speech analytics platforms, or automated scoring systems.
- Demonstrated ability to translate quality analytics into business recommendations for executive audiences.
- Understanding of healthcare regulations: HIPAA, ACA, CMS, and state insurance compliance requirements.
- Strong executive presence with excellent facilitation, coaching, and communication skills.
- Analytical mindset with experience in statistical analysis.
Responsibilities
- Own the Quality evolution roadmap, including the transition from manual, sample-based evaluation to AI-powered scoring, automated coverage, and always-on quality insights.
- Leverage AI, speech analytics, and interaction data to surface actionable coaching and process improvement opportunities.
- Design and maintain quality scorecards, evaluation criteria, and calibration standards.
- Design feedback loops connecting quality insight to action—whether that’s coaching, training updates, documentation changes, workflow updates, or technology needs.
- Conduct structured root cause analysis on critical failures, escalations, and member complaint trends.
- Build business cases for improvement initiatives with clear ROI projections and measurable impact.
- Build, lead, and develop a team of QA analysts and continuous improvement practitioners.
- Ensure compliance with healthcare regulations (HIPAA, CMS, state requirements) and lead audit readiness.
- Represent operational excellence in cross-functional forums and present findings to executive leadership.
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