Director, Quality Improvement and Performance

Job Details

The Director of Quality Improvement and Performance supports the Vice President of Quality in overseeing and executing key quality initiatives across all lines of business. This role provides leadership for quality improvement operations, regulatory program performance, and member centered quality strategies. The Director collaborates with cross functional leaders, manages Quality staff, and ensures programs are aligned with organizational goals, regulatory requirements, and evidence based best practices.

The Director plays a critical role in advancing continuous quality improvement, operational efficiency, and performance excellence. This position also contributes to the organization's goals in Medicare Stars, NCQA, Medicaid quality programs, and other state and federal performance initiatives.

Job Description

Summary
The Director of Quality Improvement and Performance supports the Vice President of Quality in overseeing and executing key quality initiatives across all lines of business. This role provides leadership for quality improvement operations, regulatory program performance, and member centered quality strategies. The Director collaborates with cross functional leaders, manages Quality staff, and ensures programs are aligned with organizational goals, regulatory requirements, and evidence based best practices. The Director plays a critical role in advancing continuous quality improvement, operational efficiency, and performance excellence. This position also contributes to the organization's goals in Medicare Stars, NCQA, Medicaid quality programs, and other state and federal performance initiatives.

Job Duties

• Quality Leadership & Strategy Support the VP of Quality in implementing the organization’s quality vision and strategic priorities. Lead day to day quality operations, ensuring alignment with organizational objectives, regulatory requirements, and member focused improvement goals. Promote a culture of continuous improvement, accountability, and high performance across the Quality Improvement and Performance team. Apply evidence based methodologies to enhance clinical quality, patient safety, service delivery, and member satisfaction.
• Program Oversight & Performance Improvement Oversee the execution of quality work plans, ensuring timely completion, accurate documentation, and effective interventions. Monitor quality metrics, identify performance gaps, and develop targeted improvement plans. Support Medicare Stars, NCQA, Medicaid HEDIS, and state program initiatives by ensuring program readiness, reporting accuracy, and operational alignment.
• Data, Analytics & Reporting Use analytics to identify trends, risk areas, and improvement opportunities; translate insights into actionable strategies. Oversee the accuracy and integrity of quality data and reporting processes. Support the preparation of reports for executive leadership, regulatory bodies, and quality committees.
• Collaboration & Stakeholder Engagement Work cross functionally with Clinical Services, Community Engagement, Population Health, Provider Relations, Customer Experience, IT/Analytics, and external partners to drive performance improvements. Communicate quality results, trends, and opportunities through reports, presentations, and committee participation. Represent the Quality Improvement and Performance department in internal committees and select external stakeholder engagements.
• Team Development & Supervision Provide leadership, coaching, and professional development to Quality Managers, Analysts, and Program Coordinators. Maintain a positive work environment that supports collaboration, learning, and staff empowerment. Ensure workload distribution, performance management, and staff accountability for key deliverables.
• Regulatory Oversight & Compliance Ensure compliance with Medicare, Medicaid, NCQA, and other regulatory/accreditation standards. Stay current on regulatory changes and support organizational readiness for audits and surveys.

Minimum Qualifications

• Bachelor’s Degree n healthcare administration, public health, business, or related field
• 7 years experience in Quality Improvement and Performance, Clinical Quality, Managed Care, or related fields. and
• 3 years years experience in a supervisory or leadership role.
• Experience with Medicare Stars, Medicaid HEDIS, NCQA, or similar programs
• Strong skills in data analysis.
• Proficiency in data analytics tools and PC-based applications (Excel, Access, Word).
• Experience leading cross-functional improvement initiatives

Preferred Qualifications

• Master’s Degree in healthcare administration, public health, business, or related field