Quality Business Operations Director (Hybrid)

About the Role

Plan, organize, and lead teams and initiatives to improve enterprise quality performance, healthcare analytics, and HEDIS outcomes across health plan populations. Develop and execute data acquisition, quality analytics, and multi-year quality improvement strategies that enhance member outcomes, customer satisfaction, and quality of care. Provide oversight of quality vendor management, medical record retrieval and validation, accreditation support, regulatory and state reporting, provider performance reporting, and cross-functional scorecard development. Ensure the accuracy and integrity of quality performance reporting while maintaining audit readiness and compliance with NCQA, regulatory, and organizational standards. Champion continuous improvement through the measurement, monitoring, and optimization of processes that drive operational excellence, HEDIS performance, Stars ratings, and regulatory compliance.

This is a hybrid role based in the greater Baltimore/Washington metropolitan area. The incumbent will work a portion of their week from home and at least two days a week at a CareFirst location, depending on business needs.

Responsibilities

• Directs the day-to-day prioritization of work for a diverse staff of quality analysts, data engineers, data analysts, and quality improvement and operations staff.
• Provides strategic oversight of vendor relationships supporting quality data or audit functions.
• Ensures the implementation and ongoing execution of Quality Improvement initiatives to improve performance, customer satisfaction, and member quality of care.
• Leads enterprise HEDIS strategy, annual submission activities, and roadmap execution, including management of work plans, timelines, data acquisition strategies, vendor and provider data exchanges, audit readiness, accreditation support, and continuous quality improvement initiatives across all lines of business.
• Drives quality performance analytics and operational improvement efforts through trend analysis, year-over-year performance reviews, HEDIS and Stars score optimization, post-audit improvement planning, and the development of actionable reporting, scorecards, and measurement frameworks.
• Maintains knowledge of current and future NCQA, NQF, CMS/Federal, State, regulatory, and healthcare quality measurement requirements and accreditation standards.
• Actively participates in or chairs committees, sub-committees, enterprise, and industry workgroups to report, champion, and advocate for quality improvement across populations.
• Directs the strategic and day-to-day activities of the department, including coaching and guiding individuals and teams to implement departmental, divisional, and organizational mission/goals.
• Recruits, retains, and develops a high-performing team. Evaluates performance, generates development plans, and sets goals within corporate policies and procedures.
• Develops annual goals and prepares, monitors, and analyzes variances of departmental budgets to control and appropriately allocate resources.

Requirements

• Bachelor's Degree in business administration, health policy, health services research, public health, economics, mathematics, computer science, or a related field. In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required.
• 8 years of experience in a healthcare, public health, health insurance, quality/process improvement, or data management business environment.
• 3 years of management experience.

Preferred Qualifications

• Training or certification in Quality or Process Improvement Methods.
• Certified Professional in Healthcare Quality certification.
• Clinical Qualification (RN/NP/PharmD).
• Data Analytics & Visualizations experience.
• 5+ years of Quality Engine management, product, or platform ownership.
• Roadmap development and audit support experience.
• Data acquisition of healthcare data through standard and non-standard data sources.
• Vendor management experience.

Skills

• Ability to perform qualitative and quantitative data analyses and create innovative strategies to address findings.
• Ability to learn the technical aspects of collection and reporting of both administrative and clinical quality measures.
• Strong computer skills, including Microsoft Office.
• Ability to mentor and coach associates to accomplish goals, provide objective performance evaluations, and implement strategies to improve individual and team-based performance.
• Ability to lead and direct analysts, clinicians, and project/program managers.
• Public speaking and presentation skills.
• Deep understanding of the Customer Experience.
• Experience in Population Health Management concepts.
• Ability to meet established deadlines and handle multiple customer service demands from internal and external customers within set expectations for service excellence.
• Effective communication and positive customer service skills, including handling demanding or challenging customers.

Pay

Salary Range: $142,560 - $264,627. The disclosed range has not been adjusted for geographic differentials. Compensation decisions depend on factors such as scope and responsibilities of the position, candidate's work experience, education/training, internal peer equity, and market/business considerations. It is not typical for an individual to be hired at the top of the range.

Benefits

CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).