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Director of Quality; Health Plan - Remote
Remote / Online - Candidates ideally in
Los Angeles, Los Angeles County, California, 90079, USA
Listed on 2026-02-10
Los Angeles, Los Angeles County, California, 90079, USA
Listing for:
Protouch Staffing
Remote/Work from Home
position Listed on 2026-02-10
Job specializations:
-
Healthcare
Healthcare Management, Healthcare Administration -
Management
Healthcare Management
Job Description & How to Apply Below
Position Overview
We are seeking an experienced and strategic Director of Quality to lead enterprise-wide quality improvement initiatives within a health plan environment. This role is responsible for driving exceptional performance across major quality programs including:
- CMS Medicare Advantage Star Ratings
- NCQA Ratings & Accreditation
- Exchange QRS Ratings
- Medicaid Quality Programs
- HEDIS and Supplemental Data Measures
Key Responsibilities
Quality Strategy & Program Leadership
- Develop and implement overarching quality strategies to achieve superior health plan ratings and accreditation performance.
- Lead cross-functional efforts to optimize clinical quality and member experience outcomes.
- Design ROI-driven quality improvement programs with measurable feedback loops.
- Drive operational processes to meet strategic quality imperatives.
- Oversee HEDIS performance improvement and supplemental data strategy.
- Ensure readiness for audits and strong outcomes in MA Stars and HEDIS measures.
- Prioritize departmental resources effectively while balancing multiple organizational priorities.
- Support capital budgeting decisions related to quality initiatives.
- Partner with clinical quality analytics teams to interpret data and develop targeted interventions.
- Oversee quality performance reporting and measure tracking.
- Bachelor's Degree in healthcare, business, or related field (Master's preferred: MPH, MHA, MBA).
- Minimum 7 years of management/supervisory experience in a health plan environment .
- At least 5 years of quality improvement program leadership , with strong emphasis on Medicare Advantage Star Ratings .
- Minimum 3 years of experience with HEDIS audits and supplemental data strategies.
- Expertise in quality methodologies such as:
- Six Sigma
- Lean
- Root Cause Analysis
- PDSA Cycles
- Certified Professional in Healthcare Quality (CPHQ) highly preferred.
- Strong background in regulatory requirements and accreditation readiness.
- Proven ability to lead matrixed teams and enterprise-wide initiatives.
- Strategic leadership and program development expertise
- Strong project and stakeholder management
- Data-driven decision-making
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