Director of Clinical Operations, Quality & Performance Programs

This is a fully remote position, open to applicants in Alabama, +34 more states.

📋 Description

• Strategize and execute plans to address clinical quality gaps, including STARS and HEDIS measures.

• Create intricate staffing models leveraging historical and real-time throughput data.

• Rapidly expand teams, technology, and workflows to accommodate volume surges and intake spikes.

• Conduct Daily Syncs, Weekly Business Reviews, and Monthly Business Reviews.

• Act as the main operational point of contact for clients.

• Present impactful client presentations and manage expectations with transparency.

• Lead preparations for both external and client-driven quality and compliance audits.

• Conduct and facilitate joint client call-listening sessions.

• Monitor agent performance, align compliance standards, and enhance training protocols.

• Oversee telephony setups, incorporating IVR and dialer strategies, along with EMR systems.

• Streamline workflows and enhance data retrieval speed.

• Manage third-party contractors and vendors in accordance with SLAs and budget constraints.

• Lead and cultivate high-performing teams.

• Collaborate across clinical, operational, data, technology, and client-facing teams.

• Utilize performance analytics, quality metrics, and actionable insights to foster accountability and improve outcomes.

⛳️ Requirements

• Minimum of 5 years of direct experience in healthcare quality operations, concentrating on Medicare STARS program metrics, HEDIS reporting, or risk adjustment.

• Strong foundational understanding of NCQA guidelines, HEDIS specifications, and Medicare Star Ratings.

• Direct experience with Looker or similar business intelligence tools.

• Practical experience navigating significant EMR platforms and cloud-based contact center telephony systems.

• High proficiency in G Suite / Google Workspace, including Docs, Sheets, Slides, and Drive.

• Ability to project staffing needs and dynamically adjust personnel based on data throughput during peak HEDIS seasons.

• 2+ years of client-facing experience managing corporate healthcare clients, payers, or enterprise accounts (preferred).

• Experience overseeing end-to-end measure closures and implementing targeted interventions (preferred).

• Background in assisting with or designing strategic STARS initiatives (preferred).

• Exceptional communication skills for translating complex operational data into actionable updates for executives and clients (preferred).

• Experience managing contracts with third-party vendors and quickly scaling temporary contractor teams (preferred).

• Ability to work at a computer terminal for extended periods and meet the stated physical requirements.

• Applicants must possess authorization to work for any employer within the U.S.

🏝️ Benefits

• Dental, vision, and multiple group medical plans.

• 401(k) retirement savings plan.

• Group life insurance.

• Accidental death and dismemberment (AD&D) insurance.

• Flexible spending account (FSA) and health savings account (HSA).

• Commuter benefits.

• Employer-funded short-term (STD) and long-term disability (LTD) insurance.

• Supplemental insurance plans, including spouse life insurance and legal insurance.

• Employee assistance program.

• Home health testing kits.

• Fertility medication discount program.

• Flexible vacation time.

• Accrued paid sick time.

• 10 paid holidays.

• 2 floating holidays for full-time non-exempt employees.

• Eight weeks of paid parental leave for eligible employees, with additional paid weeks for the birthing parent.

• 4 weeks paid caregiver leave.

• Monthly Lifestyle Spending Account allowance.

• Travel required up to 5% of the time.