Director, Quality Operations

This is a fully remote position, open to applicants in California.

📋 Description

• Work alongside the VP of Quality Operations to create and standardize enterprise metrics related to clinical excellence, quality, and patient safety, ensuring alignment with all policies and procedures, as well as local, state, federal, and CDC guidelines.

• Partner with the VP of Quality Operations and other Directors in Quality Operations to establish standardized workflows, playbooks, tools, and resources for quality operations, and to implement consistent and scalable methods for data collection, analysis, and the generation of data visualizations and reports.

• Collaborate with Analytics and Performance Excellence Teams to assess and review operational performance, focusing on continuous process enhancements, increased efficiency, and participant satisfaction.

• Monitor and evaluate data, including quality improvement (QI) plan metrics, HPMS entries, company and market initiatives, and corrective action plans (CAPs), to detect trends and opportunities for process improvement.

• Serve as a QI subject matter expert for various program and company initiatives, including working with the Compliance team to address and enhance compliance issues, CAPs, and the Fraud, Waste, and Abuse program.

• Work with the Quality Operations team and Compliance Officer to ensure that PACE program complaints are thoroughly investigated, responded to, and documented, while also supporting PACE program procedures for handling grievances and complaints in accordance with relevant state and federal regulations, policies, and compliance standards.

• Guarantee the complete and timely submission of all information mandated by regulatory agencies, including but not limited to HPMS quality reporting, CMS Quarterly calls, enrollment denials, and audit requirements.

⛳️ Requirements

• Bachelor’s degree in a relevant field; professional experience may be considered in lieu of a degree; a master’s degree in a relevant field is preferred.

• Preferred experience as a Lean Six Sigma green belt or black belt; formal QI and analytics certifications are also preferred.

• A minimum of five (5) years of experience is required, with at least three (3) years in a QI/assurance Director/Manager role within a healthcare setting, or in managing health/elder care programs with oversight of QI or compliance.

• At least three (3) years of supervisory experience demonstrating the ability to mentor and develop team members.

• Practical experience working with the California DHCS and understanding state-level regulatory expectations; experience with implementing PACE regulations is preferred.

• Required experience with regulatory compliance and audits, including preparation for and responses to CMS, DHCS, and other state/federal regulatory reviews.

• Proven experience in developing, implementing, and managing QI plans that comply with regulatory requirements.

• Strong skills in managing data and performing analyses using productivity suite software, including complex spreadsheets and data visualization tools; proficiency in Excel and PowerBI is a plus.

• Experience in developing, managing, and monitoring CAPs to address compliance and quality issues; a demonstrated ability to lead process improvement initiatives, identify gaps, and implement sustainable operational enhancements.

🏝️ Benefits

• Medical insurance coverage (Medical, Dental, Vision).

• Work/life balance - We truly mean it! Enjoy 17 days of personal time off (PTO), 12 observed holidays annually, and 6 sick days.

• 401K savings plan with matching contributions.

• Comprehensive compensation package that includes base salary and bonuses.

• Plus additional benefits!