Job Description

Overview

The Regional Quality Lead is accountable for owning market-level quality performance and strategy across HEDIS, Medicare STARs, ACO, and MSSP programs. This role will provide strategic and operational leadership to ensure regulatory compliance, optimal quality outcomes, and sustained value-based care performance across assigned markets, products, and payers. The Regional Quality Lead drives measurable improvements in patient outcomes and shared savings results through data-driven decision-making, cross-functional collaboration, and disciplined execution while serving as the primary market authority for overall quality strategy, performance oversight, and continuous improvement.

Duties & Responsibilities

• Own Market Quality Strategy & Performance
  • Serve as the accountable leader for regional quality outcomes across HEDIS, Medicare STARs, ACO, and MSSP measures.
  • Develop and execute comprehensive, market-specific quality strategies aligned with organizational priorities and payer requirements.
  • Establish performance targets and ensure delivery against quality and shared savings objectives.
  Drive Data-Informed Improvement
  • Analyze quality performance data to identify care gaps, trends, and risk areas.
  • Design and implement corrective action plans to improve measure performance and outcomes.
  • Monitor performance regularly and adjust strategies to ensure continuous improvement.
  Lead Cross-Functional Execution
  • Partners with clinical leadership, care management, operations, analytics, and provider groups to drive measure compliance.
  • Translate regulatory requirements and measure specifications into actionable operational workflows.
  • Align quality initiatives with value-based contracting and financial performance goals.
  Ensure Regulatory Compliance & Reporting Excellence
  • Oversee preparation, validation, and submission of quality reporting to CMS, NCQA, payers, and regulatory agencies.
  • Ensure adherence to accreditation, contractual, and compliance standards.
  • Coordinate chart reviews, medical record retrieval, audit readiness, and validation processes.
  • Monitor changes in quality programs and proactively adapt regional strategy.
  Executive Reporting & Market Accountability
  • Prepare and present performance reports, risk assessments, and strategic recommendations to regional and national leadership.
  • Communicate progress, barriers, and mitigation plans with clarity and executive presence.

Qualifications

• Education: Bachelor's degree in public health, nursing, healthcare administration, or related field required; Master's degree (MPH, MSN, MHA, MBA) preferred.
• Preferred certifications include CPHQ, Lean Six Sigma (or equivalent quality improvement certification), and RN credentials.
• 7+ years of progressive experience in healthcare quality, population health, or value-based care.
• 3+ years leading regional or multi-market quality programs.
• Demonstrated expertise managing HEDIS, Medicare STARs, ACO, and MSSP performance.
• Proven track record of owning market performance and delivering measurable quality improvements.
• Advanced knowledge of HEDIS, CMS STARs, ACO, and MSSP measure specifications.
• Proficiency with quality reporting systems, EHR platforms, and analytics dashboards.
• Strong Microsoft Office skills (Excel, PowerPoint, Word).
• Strategic thinker with strong market ownership mindset.
• Exceptional analytical and problem-solving abilities.
• Effective communicator with executive-level presentation skills.
• Ability to influence cross-functional stakeholders and lead change initiatives.

The working environment and physical requirements of the job include:

In-office work is performed indoors in a traditional office setting with air conditioning, artificial light, and an open workspace.

In this position you will need to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.

Travel may be required for team meetings on a quarterly basis or in-market meetings as-needed.

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.

Our Benefits

Financial Well-being

• Competitive Compensation:We offer competitive salaries to attract and retain the best talent.
• 401(k) with Employer Match:Plan for your future with our 401(k) plan and a generous 4% employer match.

Health and Wellness

• Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.
• Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.
• Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you.
• Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO, holidays, and wellness time.

Additional Perks

• Continuing Medical Education (CME) Allowance for APPs: Stay at the forefront of your field with our CME allowance.
• Commuter Benefits: Save on your commute with our commuter benefits program.
• Mileage Reimbursement: Get reimbursed for work-related travel expenses.