Director of Quality

Required

• A genuine obsession with quality in data, in work, and in outcomes: you notice what is slightly off, you cannot leave it alone, and leaders and clients trust you to say whether the work is right.
• A record of driving quality at scale. You have built the measurement, audit, and feedback systems that moved error rates in a high-volume operation, and you can show the before and after.
• Strongly data-driven: you find root causes with data, design sampling and scoring, build and use dashboards, and make decisions on numbers rather than anecdotes.
• Deep credentialing expertise: you know how a provider file is built, verified, and committee-reviewed, including primary source verification, recredentialing cycles, and the common failure modes in each.
• Experience running an audit or QA function at production scale, including sampling, scoring, calibration, and root cause analysis.
• Enough technical fluency to work with Product and Engineering: you can read a workflow, write a clear requirement, and judge what automation or system controls can do.
• 10+ years in healthcare operations, quality, or compliance, including 5+ years leading teams, with direct ownership of throughput and turnaround-time targets.
• Hands-on knowledge of NCQA credentialing standards and how they are audited, ideally from having led or supported a certification or delegation audit.
• Experience with delegation from either side: overseeing delegates at a health plan, or being overseen as a delegated credentialing organization or CVO.
• Executive presence: comfortable presenting to health plan compliance officers and senior client leaders, and holding your ground on interpretation of a standard.
• Strong written and verbal communication, and the judgment to escalate the right issues early.