Director, Health Plan Quality Program Management & Performance (Texas Health Plan)

This leadership role oversees health plan quality management and performance improvement programs, ensuring alignment with state, federal, and NCQA requirements. You will lead quality program strategies, audits, surveys, reporting, and performance improvement initiatives while helping maintain strong regulatory compliance. Working across analytics, strategic, clinical, operational, and leadership teams, you will translate quality data into actionable improvements and measurable outcomes. The role also serves as a senior subject matter resource for health plan quality activities and external state-level engagements. You will guide a specialized team, strengthen quality processes, and ensure staff are equipped to meet evolving program requirements. This is an opportunity to shape quality performance across a complex health plan environment while driving continuous improvement and better outcomes for members and providers.

• At least 8 years of healthcare experience, including a minimum of 5 years in health plan quality improvement, or an equivalent combination of relevant education and experience.
• At least 3 years of management or leadership experience.
• Advanced knowledge of HEDIS and NCQA requirements, standards, and quality program practices.
• Experience with HEDIS reporting and data collection, CAHPS improvement initiatives, and state quality improvement programs.
• Experience working with government-sponsored healthcare programs, including Medicaid, Medicare, and Marketplace programs.
• Understanding of NCQA standards, including experience interpreting requirements and applying them to health plan operations.
• Experience supporting or leading NCQA accreditation surveys and audits, as well as audits focused on state contracts and regulatory compliance.
• Experience with Performance Improvement Projects and continuous quality improvement methodologies.
• Knowledge and experience related to EPSDT and/or Texas Health Steps programs is preferred.
• Strong data analysis, manipulation, interpretation, reporting, and data-driven decision-making capabilities.
• Excellent critical-thinking, problem-solving, analytical, organizational, and project management skills.
• Strong business writing skills and excellent verbal and written communication abilities.
• Demonstrated ability to implement process improvement initiatives, drive organizational change, and manage significant cross-functional work.
• Ability to work independently in a fast-paced, deadline-driven environment and effectively operate within a highly matrixed organization.
• Strong proficiency with Microsoft Office, including Excel, as well as the ability to learn and use new information systems and software.
• Experience with provider credentialing and subcontractor monitoring is preferred.
• CPHQ or CHCA certification is preferred.
• Registered Nurse (RN) qualification is preferred; if licensed, the license must be active and unrestricted in the state of practice.
• Clinical licensure or certification may be required where mandated by state contract, regulation, business operating model, or applicable licensing requirements.