Director of Quality and Provider Engagement

Description

Join a high-performing, mission-driven organization at the forefront of value-based care and quality performance. As Director of Quality and Provider Engagement, you will have a direct seat at the table for both strategy and operations, shaping the future of care for more than 350,000 lives.

• Join one of the best-performing IPAs and ACOs in the region in quality and value-based care performance, recognized by both payers and provider groups as best in class.
•  Work alongside top professionals in value-based payment who are passionate about innovation, impact, and equity in care delivery.
• Help drive performance for a panel of over 350,000 lives, with the ability to see your strategies translate into tangible clinical and financial outcomes.
• Be part of a mid-size, nimble organization where decisions are made quickly, bureaucracy is limited, and your voice meaningfully shapes direction.
•  Sit at the same table as executive leadership for strategy and operations and collaborate daily with mission-driven talent across clinical, analytics, IT, and provider engagement.

Responsibilities:

•  Lead and mentor two high-talent, highly engaged departments: Quality and Provider Engagement, ensuring tight alignment with the company’s vision for health care quality and value.
•  Develop and execute strategic plans to improve performance in CMS Star Ratings, HEDIS, Quality Rating System metrics, and other value-based programs (ACOs and payer-specific initiatives relating to quality).
•  Provide leadership for strategic plan implementation, translating high-level goals into clear roadmaps, accountability structures, and measurable outcomes.
•  Drive regular interdisciplinary meetings to ensure quality initiatives are executed effectively, on time, and with clear ownership and follow-through.
•  Serve as operational leader and thought partner on quality, including strategy, process design, implementation, and continuous improvement
•  Lead efforts to move the IPA to consistent 4–5 Star performance across key lines of business.
•  Represent Quality in internal and external meetings, clearly communicating performance, key initiatives, and outcomes to leadership, payers, and providers.
•  Build and deepen business relationships with providers participating in quality and value partnerships; proactively problem-solve and address provider concerns.
•  Partner with internal stakeholders to design and deliver provider education and training focused on quality improvement, documentation, and risk adjustment.
•  Collaborate with Information Technology to design and continuously enhance the Point-of-Care tools, incorporating feedback from providers, internal teams, and external stakeholders.
•  Lead digital transformation for the quality function by reducing manual reporting and championing technology-enabled workflows, analytics, and automation.
•  Partner with IT, Data, and Accounting to manage the distribution of quality incentives, risk adjustment earnings, and shared savings.
•  Own the strategy and execution of programs aimed at increasing member quality, engagement, and retention across the network.

Requirements

•  Bachelor’s degree in Healthcare, Health Administration, Public Health, or a related field required; Master’s degree preferred.
•  10+ years of experience in health plans, IPAs, ACOs, or similar environments with direct exposure and responsibilities to HEDIS, Star Ratings and provider quality performance.
• Demonstrated success leading teams and initiatives that improved quality and provider engagement in a value-based care environment.
•  Strong leadership presence with the ability to interface confidently with senior executives, physicians, and external partners.
•  Proven track record of developing and mentoring high-performing teams and fostering a culture of accountability, collaboration, and continuous improvement.
•  Excellent communication skills—comfortable presenting to boards, executives, payers, and provider groups, and translating complex data into clear, actionable narratives.
•  Strong analytical and critical thinking skills, with the ability to use data to prioritize, problem-solve, and drive decision-making.
•  Deep knowledge of CMS Quality Ratings, Star Ratings, NCQA measures and methodologies. .
•  Experience designing and delivering provider education programs tied to quality and documentation performance.
•  Impeccable discretion and commitment to confidentiality.

Benefits and Compensation:

•  Competitive base salary in the range of 120,000–150,000, commensurate with experience and impact.
•  Comprehensive health benefits, including medical, vision, and dental coverage.
•  Company-paid life insurance.
•  401(k) retirement plan with a 6% corporate match.
•  Generous Paid Time Off and 13 paid holidays.
•  Hybrid work schedule that supports both collaboration and focused work time.

This role is well-suited for a top performer who has already proven their impact within a larger or more bureaucratic organization and now wants to step into a leadership position where they can move faster, have greater visibility, and directly shape both strategy and execution in a mission-driven, mid-size company.