Description
About the Role
The Director, Quality & Population Health is responsible for leading quality improvement initiatives that support performance across HEDIS, Medicare Stars, CAHPS, HOS, Patient Safety, and related quality programs. This role collaborates with clinical, operational, provider, and analytics teams to improve member outcomes, close care gaps, enhance provider performance, and advance organizational quality goals. The Director provides leadership for quality programs, delegated services, provider engagement, population health initiatives, regulatory compliance, and operational performance while supporting the development of high-performing teams.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
Quality Strategy & Performance
- Design and lead quality improvement strategies and programs across assigned business units and markets.
- Develop and execute initiatives that improve care gap closure, member outcomes, provider performance, and quality ratings.
- Collaborate with Quality, Risk Adjustment, Care Coordination, Clinical Operations, Population Health, Analytics, and Provider Relations teams to achieve organizational objectives.
- Partner with Data Analytics teams to identify opportunities for quality improvement and performance optimization through actionable reporting.
Provider & Population Health Management
- Design and implement operational workflows supporting quality measure closure, care coordination, transitions of care, annual wellness visits, and engagement of high-risk populations.
- Drive provider education and engagement initiatives that improve provider performance and adoption of value-based care programs.
- Support health equity initiatives, Social Determinants of Health (SDoH) strategies, and population health management programs.
Leadership & Organizational Development
- Lead and develop managers, supervisors, and team members while fostering a culture of accountability, innovation, collaboration, and continuous improvement.
- Support mergers, acquisitions, integrations, and organizational growth initiatives by ensuring successful implementation and alignment of quality programs.
- Be a culture-forward force for good
Qualifications
Education:
Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or related field preferred OR equivalent experience.
Experience:
- Minimum of 8 years of experience leading healthcare quality, population health, care management, delegated services, risk adjustment, or value-based care programs.
- Minimum of 5 years of leadership experience managing managers, supervisors, and cross-functional healthcare teams.
- Deep expertise in HEDIS, Risk Adjustment, Medicare Stars, CAHPS, HOS, Patient Safety, and NCQA quality programs.
- Strong understanding of Medicare Advantage, Medicaid, Commercial populations, and value-based care models.
- Demonstrated success developing and implementing quality improvement strategies that drive measurable outcomes.
- Experience partnering with providers, health plans, IPAs, ACOs, MSOs, or healthcare delivery organizations.
License/Certifications (if applicable):
- Certified Professional in Healthcare Quality (CPHQ), Registered Nurse (RN), or other relevant healthcare certification preferred.
Knowledge, Skills, and Abilities
- Extensive knowledge of CMS, NCQA, health plan delegation requirements, and healthcare regulatory standards.
- Strong analytical and operational leadership skills with the ability to translate data into actionable business strategies.
- Expertise in quality measurement, population health management, care coordination, and value-based care programs.
- Strong provider engagement and relationship management skills.
- Excellent verbal, written, presentation, and executive communication skills.
- Ability to influence stakeholders and drive results within highly matrixed organizations.
- Proven leadership, coaching, team development, and change management capabilities.
- Strong project management and strategic planning skills.
Preferred Qualifications
- Experience leading Quality, Risk Adjustment, Care Coordination, Population Health, or Health Plan Delegation programs.
- Experience managing quality initiatives within Medicare Advantage environments.
- Experience with provider engagement, provider education, and provider performance improvement programs.
- Experience supporting mergers, acquisitions, integrations, or new market expansion initiatives.
- Experience managing vendor relationships and outsourced quality programs.
- Experience with Health Equity, SDoH initiatives, and community-based population health programs.
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office at least 3 days and at home on a weekly basis. The office is located at 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148.
- The total compensation target pay range for this role is: $140,000 - $160,000. The salary range represents our national target range for this role.