Director, Health Plan Quality Program Management & Performance (Texas Health Plan)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Health Plan Quality Program Management & Performance (Texas Health Plan) based in United States. This leadership role oversees health plan quality management and performance improvement programs, ensuring alignment with state, federal, and NCQA requirements. You will lead quality program strategies, audits, surveys, reporting, and performance improvement initiatives while helping maintain strong regulatory compliance. Working across analytics, strategic, clinical, operational, and leadership teams, you will translate quality data into actionable improvements and measurable outcomes. The role also serves as a senior subject matter resource for health plan quality activities and external state-level engagements. You will guide a specialized team, strengthen quality processes, and ensure staff are equipped to meet evolving program requirements. This is an opportunity to shape quality performance across a complex health plan environment while driving continuous improvement and better outcomes for members and providers. Accountabilities: - Lead and direct the team responsible for health plan quality management and performance improvement activities, ensuring alignment with state, federal, and NCQA requirements. - Develop and implement quality program management strategies, including surveys, audits, performance improvement initiatives, and other regulatory activities. - Oversee quality program activities and performance management to maintain compliance with applicable health plan contracts, regulations, policies, and quality standards. - Represent senior leadership at internal national and regional meetings and serve as a subject matter expert during state-level meetings and quality-related engagements. - Oversee the development and completion of effective Performance Improvement Projects (PIPs), using quality improvement methodologies to drive measurable results.

- Collaborate with analytics and strategic teams to evaluate quality performance management activities, interpret results, and communicate findings to leadership. - Maintain quality program structures and processes, including policies and procedures, committee and workgroup governance, document management, reporting, and tracking of key deliverables. - Prepare clear written reports and documentation that capture quality activities, member and provider feedback, outcomes, interventions, and remeasurement results. - Ensure policies and procedures remain current with evolving state, federal, NCQA, and health plan requirements, including state-specific policy updates. - Lead training and education initiatives for quality management and performance staff to ensure understanding of regulatory requirements, workflows, policies, and contractual obligations. - Establish ongoing tracking and trending of quality requirements, operational KPIs, process reviews, and gap analyses to identify opportunities for improvement. - Apply quality improvement methodologies such as the Plan-Do-Study-Act (PDSA) cycle to support individual, team, and organizational process improvement. - Hire, develop, coach, and manage team members while maintaining accountability for team performance and department-specific quality goals. - Travel to local or regional project sites approximately 0–50% of the time for same-day business activities and up to 0–20% of the time for overnight travel, depending on health plan and state-specific requirements. Requirements: - At least 8 years of healthcare experience, including a minimum of 5 years in health plan quality improvement, or an equivalent combination of relevant education and experience. - At least 3 years of management or leadership experience. - Advanced knowledge of HEDIS and NCQA requirements, standards, and quality program practices.