Director of Quality

eternalHealth – The Next Generation of Medicare Advantage Healthcare is confusing, but it doesn’t need to be. eternalHealth is a consumer-centric, start-up Medicare Advantage Health Plan based in Boston. We are committed to creating long-lasting partnerships with our members, our providers, and you! Role Overview Reporting to the CMO of eternalHealth, the Director of Quality is responsible for the design, implementation, monitoring, and continuous improvement of the eternalHealth Quality Management Program. This role ensures compliance with all applicable CMS regulations, accreditation standards, and state Department of Insurance (DOI) requirements. The manager partners across departments, providers, and delegated entities to drive performance on HEDIS®, CAHPS®, STAR Ratings, and other quality measures, while promoting a culture of clinical excellence, compliance, and member-centered care. Key Responsibilities Develop, implement, and oversee the annual Quality Management Program Description (QMPD), Work Plan, and Annual Evaluation. Coordinate and facilitate Quality Management Committee (QMC) activities. Monitor compliance with federal, state, and accreditation requirements impacting quality initiatives. Quality Improvement & Performance Management Lead initiatives to improve HEDIS®, CAHPS®, HOS, and STAR Rating measures. Partner with internal teams to design interventions addressing care gaps, disease management, and preventive health. Develop dashboards and reports to track progress and present findings to leadership. Regulatory Compliance & Accreditation Ensure adherence to CMS Quality Improvement Project (QIP) requirements. Prepare for any accreditation surveys, CMS audits, and state DOI reviews. Maintain documentation and evidence to demonstrate program compliance. Provider & Delegated Entity Engagement Collaborate with providers and delegated entities to ensure quality obligations are met. Develop provider education and training programs related to quality performance. Participate in joint operating committees with delegated groups. Team & Cross-Functional Collaboration Work cross-functionally with Compliance, UM, Risk Adjustment, Member Services, and Population Health. Engage members through outreach programs to improve satisfaction and STAR performance. Other duties as assigned. Qualifications Education & Experience Bachelor’s degree or equivalent in nursing, Healthcare Administration, Public Health, or related field required. Minimum 5 years of experience in healthcare quality management; 2 years in Medicare Advantage or managed care. Strong knowledge of CMS Part C/D regulations, STAR Ratings, HEDIS®, CAHPS®, and NCQA/URAC standards. Proven ability to design, implement, and evaluate quality improvement programs. Strong analytical and data-driven decision-making skills. Excellent written and verbal communication skills. Strong project management and organizational skills. Ability to collaborate with providers, vendors, and internal teams. Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards. Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us at View email address on click.appcast.io. #J-18808-Ljbffr