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Clinic Management Jobs

Senior Director, Clinical Quality Governance & Regulatory

Macpower Digital Assets Edge Private Limited
  • Atlanta, GA
  • $194,700–$229,000 Per Year
  • Instant Apply
2 days ago

Job Description

Job Summary: This senior leadership role provides strategic oversight for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance. Serving as a key partner to local and national boards, this executive ensures effective governance, quality performance, and accountability across both health plan and care delivery operations.
Strategic Leadership & Talent Development:
  • Builds organizational capacity by preparing high-potential talent for advancement and overseeing the recruitment, selection, and development of a highly skilled workforce.
  • Drives continuous learning by establishing educational programs and training standards related to quality and process improvement.
  • Provides a structured framework for performance feedback and coaching, modeling continuous learning and sharing best practices across cross-functional teams.
  • Motivates and empowers teams by aligning cross-functional resource plans with broader business objectives.
  • Acts as a thought leader on industry trends, maintaining organizational alignment with external benchmarks and best practices.
  • Creates opportunities for expanded decision-making across teams and provides decisive guidance when navigating complex organizational challenges.
Operational Governance & Strategy:
  • Oversees the operations of multiple units and departments by identifying member needs and managing the allocation and completion of work assignments.
  • Translates high-level business strategy into actionable requirements, ensuring products and services meet member expectations and align with overarching goals.
  • Engages cross-functional business units to champion business plans, assuming responsibility for decision-making and the resolution of escalated issues.
  • Sets and communicates clear objectives, analyzes resource costs and forecasts, and integrates these metrics into comprehensive business plans.
  • Anticipates obstacles impacting performance, addresses gaps through immediate contingency planning, and removes barriers to process improvement.
  • Serves as a trusted subject-matter expert to executive leadership, providing critical consultation to influence the larger organizational strategy.
Quality Improvement & Metrics Integration:
  • Directs future quality improvement initiatives, acting as a technical advisor on advanced data-driven principles, problem-solving methods, and Lean/Six-Sigma concepts.
  • Establishes standard methodologies, milestones, and detailed workplans to guide the future direction of organizational process improvement.
  • Oversees the development, collection, and utilization of quality performance metrics to guide policy, consulting with stakeholders to navigate competing objectives.
  • Advocates for the integration of metric utilization into daily workflows, ensuring practical, adaptable, and multidisciplinary standards are met.
  • Evaluates, designs, and implements evidence-based guidelines and programs to reduce clinical variation, optimize patient outcomes, and ensure compliance.
  • Forecasts and revises the standards for utilization and performance reviews using multidisciplinary criteria and a systematic approach to quality improvement.
Data Analytics & Reporting:
  • Directs data collection and statistical analyses for quality improvement evaluations, special projects, and multidisciplinary reviews.
  • Establishes long-term plans for the integration of multiple utilization data reporting systems to support evidence-driven improvement.
  • Leads the collection, analysis, and presentation of clinical data to identify trends and outliers, informing high-visibility, long-term strategic goals.
  • Presents and interprets complex quality improvement metric reports for both technical and non-technical audiences, including executive management and external agencies.
Risk Management & Patient Safety:
  • Oversees current and future risk management efforts by implementing corrective action plans derived from utilization reviews, clinical record audits, claim denials, and member satisfaction surveys.
  • Utilizes intelligence gathered from root cause analysis, failure mode and effect analysis, near misses, and good catches to establish policies that mitigate future risk.
  • Defines organizational standards for escalating high-risk issues and trends.
  • Monitors, reports, and develops robust mitigation plans for all occurrences that may lead to organizational liability.
  • Oversees comprehensive patient safety management programs, including infection prevention and control.
Regulatory Compliance & Policy Development:
  • Serves as the central authority on quality improvement regulations, providing consultation on the interpretation and implementation of current policies and legislation.
  • Translates external regulatory demands into actionable program goals, advising on long-term strategies to address a shifting legislative climate.
  • Ensures process improvement initiatives comply with established internal and external regulatory requirements.
  • Supports continuous survey readiness programs to maintain strict compliance with regulatory standards.
  • Develops strategic, collaborative relationships with government bodies, regulatory agencies, and external quality organizations to advance organizational interests.
  • Forecasts the direction of future educational programs to raise awareness of changes in regulatory requirements and internal system usage.
Basic Qualifications & Requirements:
  • Master's degree in Business Administration, Health Care Administration, Nursing, Public Health, or a related field AND a minimum of eight years of experience in health care quality assurance/improvement; OR a Bachelor's degree in a related field AND a minimum of ten years of experience; OR a minimum of thirteen years of directly related experience.
  • Minimum of eight years of experience in a clinical setting, health care administration, or a directly related field.
  • Minimum of six years of experience in a leadership role managing direct reports.
  • Minimum of four years of experience managing operational or project budgets.
  • Minimum of two years of experience utilizing databases, spreadsheets, or continuous quality improvement (CQI) tools.
  • Active Registered Professional Nurse (RN) License in the state of Georgia.
  • Must possess experience as a quality leader within a large healthcare system or hospital setting, including both health plan and clinical experience.
  • Extensive functional experience in credentialing, peer review, patient safety, risk management, and quality governance.
  • Demonstrated experience managing CMS 5-Star ratings, HEDIS metrics, Joint Commission surveys, and NCQA outcomes.
  • Requirement to obtain a Professional in Patient Safety Certificate, Professional Healthcare Quality Certificate, OR Professional in Healthcare Risk Management Certificate within 24 months of hire.

Numbers & Facts

LocationAtlanta, GA
Salary$194,700–$229,000 Per Year

Skills

  • Analysis Skillsunmatched
  • Benchmarkingunmatched
  • Best Practicesunmatched
  • Budgetingunmatched
  • Business Administrationunmatched
  • Business Planunmatched
  • Business Strategyunmatched
  • Clinical Dataunmatched
  • Clinical Medicineunmatched
  • Coachingunmatched
  • Communication Skillsunmatched
  • Consultingunmatched
  • Content Management Systems (CMS)unmatched
  • Contingency Plansunmatched
  • Corrective Actionunmatched
  • Cost Analysisunmatched
  • Cost Forecastingunmatched
  • Cross-Functionalunmatched
  • Data Analysisunmatched
  • Data Collectionunmatched
  • Design Evaluationunmatched
  • Failure Mode and Effects Analysis (FMEA)unmatched
  • Forecastingunmatched
  • Government Regulationsunmatched
  • Health Insuranceunmatched
  • Health Planunmatched
  • Healthcareunmatched
  • Healthcare Administrationunmatched
  • Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
  • Healthcare Qualityunmatched
  • Hospitalunmatched
  • Improvement Metricsunmatched
  • Industry/Trade Analysisunmatched
  • Infection Controlunmatched
  • Intelligence Gatheringunmatched
  • Leadershipunmatched
  • Lean Six Sigmaunmatched
  • Maintain Complianceunmatched
  • Market Surveysunmatched
  • Medical Recordsunmatched
  • Metricsunmatched
  • National Committee for Quality Assurance (NCQA)unmatched
  • Needs Assessmentunmatched
  • Nursing Administrationunmatched
  • Operational Strategyunmatched
  • Operations Managementunmatched
  • Patient Safetyunmatched
  • People Managementunmatched
  • Performance Metricsunmatched
  • Performance Reviewsunmatched
  • Policy Developmentunmatched
  • Policy Implementationunmatched
  • Problem Solving Skillsunmatched
  • Process Improvementunmatched
  • Project Evaluationunmatched
  • Public Healthunmatched
  • Quality Assuranceunmatched
  • Quality Managementunmatched
  • Quality Metricsunmatched
  • Registered Nurse (RN)unmatched
  • Regulationsunmatched
  • Regulatory Complianceunmatched
  • Regulatory Requirementsunmatched
  • Riskunmatched
  • Risk Managementunmatched
  • Root Cause Analysisunmatched
  • Spreadsheetsunmatched
  • Standards Developmentunmatched
  • Statisticsunmatched
  • Strategic Planningunmatched
  • Talent Managementunmatched
  • Team Playerunmatched
  • Thought Leadershipunmatched
  • Trend Analysisunmatched
  • Utilization Managementunmatched

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