Sr. Director, Clinical Quality Governance & Regulatory

Sr. Director, Clinical Quality Governance & Regulatory Location: Atlanta, GA (100% Onsite) Industry: Healthcare / Health Plan & Care Delivery Operations Position Type: Full-Time, New Role Base Compensation: $194,700 – $251,900 / year (Midpoint ~$229,000; compensation flexibility available for exceptional candidates) Incentive: 20% Annual Target Bonus Relocation: Case-by-case eligibility Sponsorship: No visa sponsorship provided Executive Summary The Senior Director, Clinical Quality Governance & Regulatory provides high-level strategic oversight for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance across both health plan and care delivery operations. Serving as a trusted expert and key partner to local and national executive boards, this leader establishes overarching governance frameworks, drives evidence-based practice changes, and ensures organizational accountability. This role translates regulatory and accreditation requirements into actionable, long-term continuous improvement strategies that minimize liability, elevate clinical outcomes, and uphold operational excellence. Key Responsibilities Strategic Leadership, Governance & Team Empowerment Executive Advisory: Serve as a subject matter expert to executive leadership and boards, providing strategic guidance on clinical quality, patient safety, and liability mitigation. Team Development: Build organizational capacity, mentor high-potential staff, oversee talent selection, and drive continuous learning and cross‑functional engagement. Operational Alignment: Translate macro-level business strategies into unit goals, managing budgets, resource allocation, and operational risk across multiple departments. Quality Improvement, Data Analytics & Risk Management Data & Analytics Oversight: Direct data collection, statistical analyses, and reporting workflows (e.g., Lean/Six Sigma) to evaluate quality metrics, identify clinical trends, and present findings to executive leadership. Risk & Patient Safety: Oversee root cause analyses (RCA), failure mode and effects analyses (FMEA), near‑miss responses, and medical center liability monitoring to establish corrective policies and reduce risk. Metric Integration: Consult with cross‑functional executive stakeholders to establish practical, reachable, and standardized performance metrics integrated directly into clinical workflows. Regulatory Compliance & Accreditation Continuous Survey Readiness: Lead ongoing readiness initiatives for state, federal, and continuous survey accreditation bodies (e.g., The Joint Commission, NCQA, CMS). Agency Relations: Cultivate strong collaborative partnerships with government and regulatory agencies, staying ahead of legislative changes impacting health plan and delivery operations. Credentialing & Peer Review: Oversee processes and criteria for clinical performance reviews, credentialing, and peer reviews at the organizational level. Candidate Qualifications Must‑Have Requirements Leadership Experience: Direct executive/quality leadership experience within a large healthcare system or hospital setting AND health plan experience . Clinical Background: Hands‑on clinical experience alongside administrative leadership. Core Subject Expertise: Deep expertise in Credentialing, Peer Review, Patient Safety, Risk Management, and Quality Governance . Regulatory & Quality Programs: Proven track record with: CMS 5‑Star ratings HEDIS metrics The Joint Commission survey leadership NCQA outcomes Minimum Education & Work Experience Experience: Minimum 8 years of experience in a clinical setting, healthcare administration, or related field. Minimum 6 years in a leadership role managing direct reports. Minimum 4 years managing operational or project budgets. Minimum 2 years working with databases, spreadsheets, or Continuous Quality Improvement (CQI) tools. Education & Experience Combinations: Master’s Degree (MBA, HCA, MSN, MPH, or related) + 8+ years of healthcare quality assurance/improvement experience OR Bachelor’s Degree (BA/BS in related field) + 10+ years of healthcare quality assurance/improvement experience OR 13+ years of progressive experience in healthcare quality assurance/improvement. Licenses & Certifications Active RN License: Current Registered Professional Nurse License in the State of Georgia (or clear path to obtain prior to hire). Certifications: Must possess (or obtain within 24 months of hire) at least one of the following: Certified Professional in Patient Safety (CPPS) Certified Professional in Healthcare Quality (CPHQ) Certified Professional in Healthcare Risk Management (CPHRM) #J-18808-Ljbffr Fox Point Recruitment LLC