Director, Quality Operations

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

📋 Description

• Collaborate with the Vice President of Quality Operations to create and standardize enterprise metrics related to clinical excellence, quality, and patient safety while adhering to all policies and procedures, as well as local, state, federal, and CDC guidelines.

• Work alongside the VP of Quality Operations and other Directors within Quality Operations to establish standardized quality workflows, playbooks, tools, and resources, and to implement uniform and scalable methods for data collection, analysis, and the generation of visualizations and reports.

• Partner with Analytics and Performance Excellence Teams to assess and review operational performance for ongoing 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 uncover trends and opportunities for process enhancement.

• Serve as a QI subject matter expert on program and company initiatives as needed, including collaboration with the Compliance team to oversee and improve 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, addressed, and documented, while also supporting PACE program procedures for handling grievances and complaints in accordance with applicable state and federal regulations, policies, and compliance standards.

• Guarantee the complete and timely submission of all required information to 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 related area is preferred.

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

• 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 environment or managing health/elder care programs with a focus on QI or compliance.

• At least three (3) years of supervisory experience with a proven ability to mentor and develop team members.

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

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

• Demonstrated experience in developing, implementing, and managing QI plans in accordance with regulatory standards.

• Proven capabilities in managing data and performing analyses using productivity 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 concerns; a proven track record of leading process improvement initiatives, identifying gaps, and implementing 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.

• A comprehensive compensation package that includes base salary and bonuses.

• Additional benefits available!