Director, Quality & Process Improvement

Job Title: Senior Director of Quality Operations & HEDIS Strategy

Client Industry: Managed Care / Health Insurance

Location: 100% Remote (U.S. Based)

Compensation: $118k – $219k + Bonus & Comprehensive Benefits

A leading national healthcare organization is seeking a strategic and technical leader to spearhead their HEDIS Audit and Quality Improvement initiatives. Our client is a major player in the health equity space, serving millions of members nationwide. They are looking for a process-driven expert who can bridge the gap between regulatory compliance and operational excellence.

Role Overview:

As the Senior Director, you will be the primary architect of the organization’s HEDIS audit readiness. You will lead cross-functional teams to ensure that all clinical data, reporting, and process documentations are audit-ready and compliant with NCQA standards. This is a high-impact role requiring a mix of high-level strategy and hands-on management of complex regulatory timelines.

Core Responsibilities:

• Audit Ownership: Lead the end-to-end HEDIS audit cycle, including the management of Roadmaps, Section 5 documentation, and direct engagement with external auditors.
• Process Engineering: Design and implement sophisticated process maps and workflows to streamline quality assurance and performance improvement projects.
• Regulatory Liaison: Act as the primary point of contact for leadership and auditing bodies to ensure seamless communication and successful audit outcomes.
• Operational Intelligence: Develop and oversee advanced dashboards and data tracking tools to monitor organizational effectiveness and HEDIS measure accuracy.
• Compliance & Excellence: Ensure all business units remain in strict alignment with NCQA, URAC, and Joint Commission standards.
• Strategic Training: Oversee the development of policies, procedures, and training modules to instill a culture of quality adherence across the enterprise.

Candidate Requirements:

• Education: Bachelor’s degree in a relevant field (Healthcare Admin, Business, or Clinical).
• Experience: 6+ years of leadership experience specifically within Quality Management or Process Improvement.
• HEDIS Expertise: In-depth, practical experience with NCQA HEDIS measures and the annual audit lifecycle is highly preferred.
• Technical Proficiency: Strong background in research methodologies, workflow management software, and data analysis.
• Accreditation Knowledge: Familiarity with URAC and/or Joint Commission standards is a significant plus.
• Leadership Style: Proven ability to drive accountability among diverse functional teams in a fast-paced, remote environment.

What Our Client Offers:

This organization is recognized for its commitment to workplace flexibility. They offer a robust total rewards package including:

Competitive base salary with performance-based incentives.

Comprehensive medical, dental, and vision coverage.

401(k) with company match and employee stock purchase options.

Tuition reimbursement and professional development support.

Generous PTO and holiday schedule.

Our client is an Equal Opportunity Employer. We encourage applicants from all backgrounds to apply.