Director, Market Quality Improvement
New
J
JobgetherHealthcare
United StatesFull-TimeDirector
Salary$113,000–$197,700
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Job Details
- Experience
- At least 7 years of experience in managed care, government-sponsored healthcare programs, or healthcare operations.
- Required Skills
- Data AnalysisMicrosoft ExcelStakeholder management
Requirements
- Bachelor’s degree in Healthcare Administration, Business, Public Health, or a related field (Master’s degree preferred).
- At least 7 years of experience in managed care, government-sponsored healthcare programs, or healthcare operations.
- At least 3 years of experience leading Medicare, Medicaid, or other highly regulated government healthcare programs.
- Medicare STARS leadership experience is strongly required.
- Demonstrated experience with healthcare regulatory compliance, audits, contractual performance management, or accreditation readiness.
- Previous people-management or matrixed leadership experience.
- Strong knowledge of CMS and state quality program requirements and regulatory oversight.
- Ability to manage quality measures, performance metrics, and turn data into actionable improvement strategies.
- Proficiency with Microsoft Excel, Word, PowerPoint, and data visualization tools.
- Ability to travel occasionally, up to approximately 15%.
Responsibilities
- Lead the execution of quality strategy across assigned lines of business, ensuring alignment with contractual obligations, regulatory requirements, and enterprise quality objectives.
- Oversee quality and performance measures covering access to care, clinical quality, beneficiary experience, network adequacy, utilization, and operational performance.
- Monitor performance against contractual and regulatory standards, identify emerging risks and gaps, and implement corrective action plans where necessary.
- Partner with Compliance, Legal, Internal Audit, and other stakeholders to maintain regulatory readiness, support audits, and address external findings.
- Collaborate with Analytics to develop dashboards, reporting, and actionable insights that support quality oversight and data-driven decision-making.
- Support provider engagement around quality requirements, performance expectations, documentation, access standards, and improvement initiatives.
- Lead governance meetings, workgroups, and operational forums focused on quality performance, compliance, and organizational readiness.
- Track changes to CMS and state guidance, regulations, and contracts, translating them into actionable quality and operational plans.
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