Director, Quality Programs

About the role

The right candidate will bring expertise in MSSP Quality performance, data ingestion, and client-facing engagement, combined with a genuine passion for and deep understanding of value-based care quality improvement.

Areas of Expertise and Impact

• Execution & Performance Management: Independently own day-to-day execution of the MSSP Quality program, including inter-team coordination and submission workflows across HEDIS, CMS Stars, MIPS, and Medicaid quality programs.

• Strategy & Reporting: Develop multi-year strategies for MSSP Quality performance, lead risk mitigation strategy for MSSP quality, and support deal-level measure feasibility assessments and state-by-state Medicaid quality alignment for the growth team.

• Data & Audit: Own all supplemental data submission workflows, including chart retrieval, data integrity checks, and PSV audit protocols; serve as sign-off authority before any supplemental data submission reaches a payer.

• Partnership & Product Collaboration: Build and maintain strong relationships with key internal stakeholders, and work directly with network practices to co-design gap closure workflows.

Qualifications

• At least 10 years of experience in healthcare, with the majority in quality program management at a provider, ACO, or health plan.

• At least 6 years of direct, hands-on management of end-to-end quality submissions — including expert-level understanding of MSSP quality program policies, measures, and reporting requirements.

• Expert-level knowledge of HEDIS, MIPS, eCQMs, MSSP ACO quality reporting, and CMS Stars — able to resolve measure-level questions cold without escalation.

• Demonstrated ability to build a quality function or program from scratch, not just operate within an established one.

• Relentless focus on data: uses numbers to guide strategic decisions; mastery of Excel/Google Sheets and PowerPoint/Google Slides.

• Technical experience with EHR integrations or other data source integrations; fluency in how quality measure data flows through structured EHR documentation (Epic + at least one other platform).

• Proven ability to lead through influence — building alignment across senior leaders, cross-functional teams, and external stakeholders without formal authority.

• Deep familiarity with NCQA supplemental data standards, PSV audit protocols, and payer-specific submission requirements.

• Track record of peer-level engagement with payer quality leadership, plan medical directors, or equivalent external stakeholders.

• Strong leadership, communication, and interpersonal skills; able to navigate and manage relationships across all levels, both upward and downward.

• Bachelor's degree in Healthcare, Public Health, or a related field. Willing to substitute relevant career experience in lieu of degree.