Sr. Director, Clinical Quality Governance & Regulatory

Job Summary

We are seeking a Senior Director, Clinical Quality Governance & Regulatory to lead clinical quality, patient safety, risk management, credentialing, peer review, quality governance, and regulatory compliance across a complex healthcare and health plan environment.

Key Responsibilities

• Lead clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance programs
• Oversee quality governance, continuous survey readiness, and Joint Commission/accreditation requirements
• Develop and monitor quality improvement strategies, corrective action plans, and performance metrics
• Lead data analysis and reporting related to HEDIS, CMS Five-Star Ratings, NCQA outcomes, and other quality measures
• Use RCA, FMEA, Lean, Six Sigma, and other quality improvement methodologies to reduce risk and improve outcomes
• Serve as a strategic advisor to executive leadership, boards, regulatory agencies, and external stakeholders
• Lead, develop, and mentor quality teams while managing operational and project budgets

Required Qualifications

• Senior quality leadership experience in a large healthcare system or hospital setting
• Experience in a health plan environment and clinical quality operations
• Experience with credentialing, peer review, patient safety, risk management, quality governance, HEDIS, CMS Five-Star Ratings, Joint Commission surveys, and NCQA outcomes
• 8+ years of experience in healthcare quality, clinical care, healthcare administration, or a related field
• 6+ years of leadership experience with direct reports
• 4+ years managing operational or project budgets
• 2+ years using databases, spreadsheets, or CQI tools
• Master’s degree + 8 years of relevant experience, Bachelor’s degree + 10 years, or 13+ years of relevant experience
• Georgia RN license required
• Must obtain CPPS, CPHQ, or CPHRM certification within 24 months of hire