Director, Clinical Quality

Your Role

Reporting to the VP of Clinical Quality, the role of the Director is critical to the success of Blue Shield of California and the Clinical Quality department in realizing its goals and objectives.  This individual will play a key role as part of the Quality team in delivering and collaborating on all aspects of quality outcomes. Establishes strategic plans, policies, and procedures at all levels and with all or critical operational departments to ensure quality programs will meet or exceed guidelines or requirements.

Specifically, the Director, Quality Management role will be accountable for ensuring that all Quality Management functions (Regulatory oversight, Committees, Policies and Procedures) are optimized resulting in audit readiness/regulatory compliance, ongoing NCQA Accreditation, and a high-quality program.

Your Work

In this role, you will:

• Responsible for ensuring that Quality policies and procedures are in alignment with regulator expectations and in favor of delivering a high-quality program for the organization
• Responsible for organizing and facilitating Quality Committees and Subcommittees to drive a high-quality program for the organization while aligning with regulator requirements
• Ensure audit readiness for Quality Management
• Support NCQA Accreditation processes

Your Knowledge and Experience

• Minimum of 10 years prior relevant experience, including 6 years of management experience. 
• Bachelor’s degree in Nursing, Public Health or other related field
• Requires in-depth knowledge of committee oversight, regulatory quality oversight, NCQA accreditation and standards.
• Prior experience driving and governing Quality Committees at a large health plan
• Comfortable with collaborating with executive audiences