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| As the Director of Quality Programs and Services, you will be responsible for leading and overseeing all aspects of quality assurance, program development, and service delivery within our network. This role requires a strategic thinker with a strong background in quality management, program development, and leadership. |
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Strategic Leadership: Develop and execute a comprehensive strategy for advancing quality initiatives within the value-based care framework. Collaborate with organizational leadership to align quality goals with risk-based payer contracts, organizational objectives, industry best practices & `best in class? innovations.
Performance Measurement & Reporting: Participate in the development and maintenance of performance measurement systems to track key quality indicators and metrics. Facilitate the development of regular reports to communicate performance outcomes, trends, and areas for improvement to relevant stakeholders, including executive leadership, clinical teams, and external partners.
Quality Assurance: Coordinate with relevant VBCI Leadership establish and maintain rigorous quality assurance processes to ensure that all programs and services meet or exceed internal and external policies & standards. Develop and implement process and performance metrics and evaluation processes to assess the effectiveness and impact of all quality programs and services.
Program Development: Lead the development of new programs and services in response to identified needs and other requirements. Includes establishing and partnering in consistent and reliable approaches to care gap closure, HCC coding quality, and RAF score optimization. Lead efforts to continuously improve the quality, efficiency, and effectiveness of programs and services through innovation, process optimization, and best practices.
Quality & Safety Improvement Initiatives: Identify potential risks and vulnerabilities related to quality of care and patient safety within the value-based care model. Develop and implement risk mitigation strategies to minimize adverse events and optimize patient outcomes. Lead the design, implementation, and evaluation of quality improvement initiatives aimed at enhancing clinical outcomes, patient satisfaction, and operational efficiency, in coordination with other areas (e.g., Population Health, Care Coordination, Clinical Documentation Improvement, Ambulatory Clinics, etc.)
Departmental Management: Provide leadership and direction to a team of quality specialists, program managers, and other staff members, fostering a culture of excellence, collaboration, and continuous improvement. Oversee the budgeting process for quality programs and services, ensuring efficient allocation of resources and adherence to financial targets.
Collaboration & Stakeholder Engagement: Foster collaboration and partnerships with internal and external stakeholders, including healthcare providers, payers, community organizations, and regulatory agencies. Work closely with cross-functional teams to implement quality improvement initiatives meeting stakeholder needs and expectations. Promote a culture of continuous learning and improvement.
Technology and Data Analytics: Leverage current and emerging technologies for efficiency and high reliability of processes and results. Analyze data in partnership with relevant departments and resources, ensuring accurate and actionable insights to guide the Quality program. Actively engage stakeholders, promoting optimal use of data and technology to drive better outcomes.
Regulatory Compliance: Stay abreast of relevant laws, regulatory requirements and accreditation standards related to value-based care quality initiatives. Ensure organizational compliance with applicable regulations and standards, and lead efforts to prepare for and respond to audits and assessments.
Education & Training: Develop and deliver educational programs and training sessions to promote awareness and understanding of value-based care principles, quality improvement methodologies, technological solutions, optimized HCC Coding strategies, and other related best practices among clinical and non-clinical staff. |
| EDUCATION: |
Required:
Bachelor?s degree
MBA or MHA
Preferred:
Clinical degree in Nursing or Pharmacy |
| EXPERIENCE: |
Required:
Minimum of 5 years of progressive leadership experience in quality, process improvement, RAF/HCC coding, and/or healthcare program development within an integrated delivery system.
Demonstrated expertise in developing and implementing quality strategies.
Strong understanding of healthcare delivery systems, value-based care models, and payer contracts and metrics.
Proven track record of successfully developing and implementing programs and services that meet or exceed risk-based contracting quality standards and deliver measurable results.
Minimum of 3 years of experience in Value-based care, a CIN, or an ACO.Experience working in a regulated industry or with regulatory agencies preferred.
Preferred:
Experience working in a regulated industry or with regulatory agencies preferred.
Leadership experience preferably in a value based, ACO, or clinically integrated environment. |
| LICENSURE/CERTIFICATION/REGISTRY/LISTING: |
Required:
Valid Driver's License
Preferred:
Registered nurse or pharmacist if applicable
Certified Professional in Healthcare Quality (CPHQ) |
Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We believe in offering equal opportunities for employment to all applicants and employees, regardless of their race, religion, age, sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or any other characteristic protected by law. Our hiring and employment choices are based on each individual's qualifications, skills and performance. We believe that by embracing the diversity of our team, we can better serve our patients, communities and each other.
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Cone Health
Jul 08, 2025