Director, Quality Operations

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. With a community-based approach, Zing Health recognizes the importance of social determinants of health in keeping individuals and communities healthy. The company aims to return the physician and the member to the center of the health care equation, offering personalized plans, access to specialized facilities, and a dedicated care team.

About the role

The Director, Quality Operations is responsible for supporting the development and implementation of quality improvement interventions and audits. This role acts as a subject matter expert on HEDIS measures, including providing education on appropriate medical record documentation and coding. The Director will assist in resolving deficiencies impacting Zing Health plan’s compliance with State and Federal standards for HEDIS.

Responsibilities

• Acts as subject matter expert for The Healthcare Effectiveness Data and Information Set (HEDIS) measures, audits, and submissions.
• Develops and implements targeted interventions related to Stars performance including HEDIS, pharmacy measures, customer service, and administrative measures.
• Implements key quality strategies, including initiation and management of provider, member, and/or community interventions to achieve optimal health outcomes.
• Develops, documents, and administers enterprise quality and accreditation strategies, activities, and programs including the auditing and implementation processes.
• Collaborates with leadership to ensure compliance with federal regulations and health plan state regulations.
• Develops and monitors the supplemental HEDIS data file and abstraction processes.
• Leads documentation and evidence gathering, citation, and submission of NCQA submissions, including Health Plan and SNP submissions.
• Advises and educates Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines, and HEDIS ICD-10 CPT coding in accordance with NCQA requirements.
• Collaborates with Provider Network to improve provider performance in areas of Quality, Risk Adjustment, and Operations (claims and encounters).
• Develops annual Quality Management Program Evaluation and Quality Management Work Plan; monitors Quality Management work plan progress at regular intervals and reports to QM Committee.
• Facilitates quality improvement committee functions and meetings.
• Performs other related duties and/or projects as assigned.

Requirements

• Bachelor’s degree in Healthcare, Clinical Profession, or Public Health.
• Three years of direct experience leading or performing HEDIS reporting activities or five years of management experience, including experience overseeing HEDIS and Stars reporting.

Preferred Qualifications

• Master’s degree preferred.
• Registered Nurse licensure.

Skills

Must exhibit an intermediate level of expertise in the following:

• Healthcare Effectiveness Data and Information Set (HEDIS) experience.
• Medicare Stars ratings including HEDIS, CAHPS, and Pharmacy measures.
• Data analysis and continuous quality improvement processes.
• Demonstrated experience aligning data sources to HEDIS specifications for proper extract requirements.
• Experience integrating clinical data with administrative data and developing supplemental data sets.
• Strong knowledge of healthcare delivery.
• Excellent communication skills — listening, speaking, and writing.
• Personal management skills — plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments.
• Teamwork — ability to work well with one or more groups.
• Interpersonal effectiveness — relate to co-workers and build relationships with others in the organization.
• Strong work values — dependability, honesty, and a positive attitude.
• Technical Skills: Intermediate proficiency in Microsoft Excel, Word, Outlook, and PowerPoint.

Member-centric Impact

Leads enterprise-wide quality strategy focused on CMS Star Ratings, HEDIS performance, CAHPS improvement, and quality interventions. Priorities include measure gap closure, provider collaboration, medication adherence, and member experience initiatives. Measurable impact includes Star Ratings improvement, increased bonus revenue, higher preventive screening rates, improved CAHPS scores, and enhanced quality audit outcomes.

Benefits

• A competitive salary based on the market.
• Medical, Dental, and Vision coverage.
• Employer-Paid Life Insurance.
• Paid Maternal Leave.
• Paid Paternal Leave.
• 401(K) match up to 4%.
• Paid-Time-Off.
• Employee Assistance Programs.
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, and ID Protection.