Director of Quality
New
C
CertifyOSHealthcare credentialing
Remote USFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- 10+ years in healthcare operations, quality, or compliance, including 5+ years leading teams
- Required Skills
- Quality Assurance
Requirements
- Bring 10+ years of experience in healthcare operations, quality, or compliance, including 5+ years leading teams.
- Have direct ownership of operational throughput and turnaround-time targets.
- Demonstrate a record of building measurement, audit, and feedback systems that improved quality in a high-volume operation.
- Have deep provider credentialing expertise, including provider file development, verification, committee review, primary source verification, and recredentialing cycles.
- Have experience running a production-scale audit or QA function, including sampling, scoring, calibration, and root-cause analysis.
- Have hands-on knowledge of NCQA credentialing standards and how they are audited.
- Have experience with delegation oversight at a health plan or as a delegated credentialing organization or CVO.
- Use data to analyze root causes, design sampling and scoring, and build and use dashboards.
- Be technically fluent enough to read workflows, write clear requirements, and assess automation and system controls.
- Be comfortable presenting to health plan compliance officers and senior client leaders and interpreting standards.
- Nice to have: experience at a CVO, delegated health plan credentialing department, or credentialing technology company.
- Nice to have: familiarity with URAC, The Joint Commission, CMS, state credentialing requirements, SOC 2, or HITRUST audits.
- Nice to have: experience with SQL, BI dashboards, or workflow analytics.
Responsibilities
- 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.
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