Director, Quality & Process Improvement - HEDIS Audit

Overview

A healthcare organization is seeking a Director of Quality and Process Improvement to spearhead quality enhancement efforts and oversee compliance and readiness for HEDIS audits. The individual in this position will be accountable for managing audit activities, ensuring regulatory adherence, driving process enhancements, and collaborating with multiple departments to guarantee precise and timely audit submissions.

Key Responsibilities

• Lead the planning, execution, and compliance of HEDIS audits, ensuring submission accuracy and timeliness.
• Manage and maintain all audit documents including roadmaps, measure specifications, regulatory guidelines, and communication with auditors.
• Act as the main liaison for auditors and senior leadership throughout the audit lifecycle.
• Direct initiatives aimed at quality and process enhancement through methods such as process mapping and optimizing workflows.
• Create and sustain dashboards, reports, and metrics to track quality and operational performance.
• Oversee quality assurance programs, policy creation, staff training, and regulatory compliance audits.
• Assess operational procedures to identify and implement improvements in efficiency, quality, and compliance.
• Research, adopt, and enforce best practices, policies, and process enhancements.
• Ensure all activities are aligned with accreditation standards and healthcare regulations.
• Evaluate and apply new technologies and tools for process improvement.
• Develop strong cross-functional partnerships to support organizational goals related to quality.

Qualifications

• Bachelor’s degree in a relevant field.
• At least six years of experience in quality assurance, process improvement, or operational excellence.
• Preferably experienced in the healthcare industry.
• Thorough understanding of HEDIS measures, audit protocols, and regulatory compliance requirements.
• Experience with process mapping, workflow design, and employing quality improvement techniques.
• Knowledge of accreditation standards and healthcare quality frameworks is a plus.
• Strong analytical skills, project management capabilities, and adeptness in stakeholder engagement.
• Excellent leadership and communication skills.

Benefits Offered

• Competitive salary with a comprehensive benefits package.
• Flexible working options with remote arrangement.
• Retirement savings plans and wellness initiatives.
• Support for professional growth including tuition assistance.
• Chance to lead quality enhancement projects across a national healthcare organization.

Additional Information

Industry sectors include Healthcare, Managed Care, Health Insurance, and Healthcare Quality & Compliance.