Job Posting Location:Remote - USA
Job Title:Director, Quality Performance Operations
Job Description:Candidates must be legally authorized to work in the United States without employer sponsorship, now or in the future.The Director, Quality Operations is a hands-on, results-driven operator responsible for disciplined, scalable execution across HEDIS, Stars, clinical quality programs, and the In-Home Assessment (IHA) program. Reporting to the Senior Director, Quality, this role provides operational leadership for the Quality Operations team and directly oversees the Senior Program Manager, Quality Operations. The Director serves as the critical connection point between the centralized operations team and regional and market teams, between operations and technology, and alongside the Payor team with our health plan partners, ensuring priorities are clear, commitments are tracked, and work gets done. This role is built for a strong operator with a bias for action: someone who brings structure to complexity, holds teams and partners accountable, closes loops, and consistently delivers measurable improvement in quality results.
Essential Job Functions:
1. Operational Leadership and ExecutionLead the day-to-day operating model for enterprise quality programs, including HEDIS, Stars, ACO/MSSP quality initiatives, clinical quality programs, and the IHA program.
Execute priorities set by the Senior Director through annual operating plans, workstreams, milestones, accountabilities, and measurable outcomes.
Directly manage and develop the Senior Program Manager, Quality Operations, and provide leadership across the broader quality operations team.
Serve as the primary liaison between the centralized Quality Operations team and regional and market teams, ensuring enterprise priorities, workflows, and expectations are clearly communicated, adopted, and executed locally, and that market needs, barriers, and feedback are surfaced and resolved centrally.
Establish and run a disciplined operating cadence, including action-item tracking, issue logs, escalation paths, and KPI scorecards, so that commitments are owned, deadlines are met, and open items are driven to closure.
2. IHA Program Oversight
Own end-to-end operational oversight of the IHA program, including implementation planning, workflow design, market readiness, vendor coordination, KPI monitoring, and issue resolution.
Partner with market, clinical, analytics, coding, risk adjustment, and health plan teams to ensure IHA activities support quality and clinical objectives.
Monitor IHA program productivity, completion, quality, member experience, documentation, and downstream outcomes; implement corrective actions when results are below target.
Drive consistent IHA execution across regions and markets, holding vendors and internal partners accountable to targets and ensuring identified gaps and follow-up needs are closed.
3. Quality Program Operations
Ensure operational readiness for HEDIS/Stars submissions, audits, roadmaps and health plan deliverables.
Coordinate enterprise and market-level quality calendars, dependencies, risks, and deliverables across cross-functional teams.
Drive continuous improvement by evaluating workflows, identifying root causes, and implementing scalable solutions.
4. Technology Partnership and Prioritization
Serve as the liaison between Quality Operations and the Technology and Product teams, translating operational needs into clearly defined business requirements, use cases, and success measures.
Lead prioritization of quality-related technology requests and enhancements based on quality impact, operational risk, and timing; maintain a transparent backlog and roadmap in partnership with Technology.
Track delivery of technology work against committed timelines, coordinate user acceptance testing and rollout with operations and market users, and escalate risks or delays as needed.
5. Health Plan Partnership
Work alongside the Payor team to track, manage, and follow up on open health plan items, requests, and deliverables, ensuring clear ownership and timely resolution.
Attend and actively participate in health plan meetings, including Joint Operating Committees (JOCs) and quality working sessions, to build strong partnerships with health plan partners and drive quality results.
Lead operational discussions with health plans on quality programs, data exchange and supplemental data, gap closure, and quality results; ensure action items from health plan meetings are documented and completed.
Maintain a consolidated view of health plan quality commitments, programs, and incentive opportunities across markets to inform prioritization and resource planning.
6. Stakeholder and Vendor Management
Build collaborative relationships with Regional Quality, Market, Payor, Clinical, Analytics, Coding, Risk Adjustment, Technology, Product, Finance, and other enterprise partners.
Lead operational discussions with vendors and external partners; monitor results against service levels, quality standards, and contractual commitments.
Support materials and deliverables for executive, Board, JOC, CQC, and other governance forums as requested.
Other Job Functions:- Understand, adhere to, and implement the Company's policies and procedures.
- Provide leadership, coaching, and mentoring to employees and team members.
- Support hiring, employee reviews, workforce planning, and development activities for the function.
- Demonstrate excellent communication, customer service, attention to detail, and accountability.
- Travel as required.
- Other duties as assigned.
Required Qualifications: Minimum Experience- Minimum of 9 years of applicable healthcare quality, clinical operations, or program operations experience, including at least 3 years of people management experience.
- Demonstrated experience leading complex, cross-functional quality programs in Medicare Advantage, value-based care, HEDIS/Stars, ACO/MSSP, or a comparable environment.
- Experience overseeing large-scale operational programs, vendors, KPI tracking, and process improvement; IHA or in-home clinical program experience strongly preferred.
- Strong working knowledge of Stars, HEDIS, CAHPS, CMS and NCQA requirements, quality measurement, and healthcare operations.
- Proven track record as a strong, hands-on operator who drives execution, holds teams and partners accountable, and delivers results in a fast-paced, matrixed environment.
- Experience partnering directly with health plans (e.g., JOCs, quality program partnerships) and with technology teams on requirements and prioritization strongly preferred.
2.Education/Licensure:Bachelor's degree required in healthcare administration, public health, nursing, business, data analytics, or a related field; advanced degree preferred
Skills and Abilities:
1. Strong operator with a bias for action; able to take ambiguous problems, build a plan, and drive them to completion
2. Ability to manage multiple priorities, workstreams, and deadlines simultaneously with minimal supervision
3. Skilled at influencing and aligning cross-functional, regional, market, and external stakeholders without direct authority
4. Ability to translate operational needs into clear technology requirements and priorities
5. Excellent analytical, problem-solving, and organizational skills; uses data to monitor results and drive decisions
6. Exceptional attention to detail and follow-through; ensures open items are tracked and closed
7. Language Skills: Strong communication skills both written and verbal to work with multiple internal and external clients in a fast-paced environment
8. Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
9. Reasoning Ability: Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.
10. Computer Skills: Advanced proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint); experience with project and work management tools preferred
Essential Physical Functions:
These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all the functions of the job with or without accommodation.
Location:Remote - GA
Pay Range:$129,700.00 - $162,100.00
Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.
