Pursue Your Passion with Purpose

Senior Leadership Role

This senior leadership role provides strategic oversight for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance. Serving as a key partner to local and national boards, this executive ensures effective governance, quality performance, and accountability across both health plan and care delivery operations.

Strategic Leadership & Talent Development

• Builds organizational capacity by preparing high-potential talent for advancement and overseeing the recruitment, selection, and development of a highly skilled workforce.
• Drives continuous learning by establishing educational programs and training standards related to quality and process improvement.
• Provides a structured framework for performance feedback and coaching, modeling continuous learning and sharing best practices across cross-functional teams.
• Motivates and empowers teams by aligning cross-functional resource plans with broader business objectives.
• Acts as a thought leader on industry trends, maintaining organizational alignment with external benchmarks and best practices.
• Creates opportunities for expanded decision-making across teams and provides decisive guidance when navigating complex organizational challenges.

Operational Governance & Strategy

• Oversees the operations of multiple units and departments by identifying member needs and managing the allocation and completion of work assignments.
• Translates high-level business strategy into actionable requirements, ensuring products and services meet member expectations and align with overarching goals.
• Engages cross-functional business units to champion business plans, assuming responsibility for decision-making and the resolution of escalated issues.
• Sets and communicates clear objectives, analyzes resource costs and forecasts, and integrates these metrics into comprehensive business plans.
• Anticipates obstacles impacting performance, addresses gaps through immediate contingency planning, and removes barriers to process improvement.
• Serves as a trusted subject-matter expert to executive leadership, providing critical consultation to influence the larger organizational strategy.

Quality Improvement & Metrics Integration

• Directs future quality improvement initiatives, acting as a technical advisor on advanced data-driven principles, problem-solving methods, and Lean/Six-Sigma concepts.
• Establishes standard methodologies, milestones, and detailed workplans to guide the future direction of organizational process improvement.
• Oversees the development, collection, and utilization of quality performance metrics to guide policy, consulting with stakeholders to navigate competing objectives.
• Advocates for the integration of metric utilization into daily workflows, ensuring practical, adaptable, and multidisciplinary standards are met.
• Evaluates, designs, and implements evidence-based guidelines and programs to reduce clinical variation, optimize patient outcomes, and ensure compliance.
• Forecasts and revises the standards for utilization and performance reviews using multidisciplinary criteria and a systematic approach to quality improvement.

Data Analytics & Reporting

• Directs data collection and statistical analyses for quality improvement evaluations, special projects, and multidisciplinary reviews.
• Establishes long-term plans for the integration of multiple utilization data reporting systems to support evidence-driven improvement.
• Leads the collection, analysis, and presentation of clinical data to identify trends and outliers, informing high-visibility, long-term strategic goals.
• Presents and interprets complex quality improvement metric reports for both technical and non-technical audiences, including executive management and external agencies.

Risk Management & Patient Safety

• Oversees current and future risk management efforts by implementing corrective action plans derived from utilization reviews, clinical record audits, claim denials, and member satisfaction surveys.
• Utilizes intelligence gathered from root cause analysis, failure mode and effect analysis, near misses, and good catches to establish policies that mitigate future risk.
• Defines organizational standards for escalating high-risk issues and trends.
• Monitors, reports, and develops robust mitigation plans for all occurrences that may lead to organizational liability.
• Oversees comprehensive patient safety management programs, including infection prevention and control.

Regulatory Compliance & Policy Development

• Serves as the central authority on quality improvement regulations, providing consultation on the interpretation and implementation of current policies and legislation.
• Translates external regulatory demands into actionable program goals, advising on long-term strategies to address a shifting legislative climate.
• Ensures process improvement initiatives comply with established internal and external regulatory requirements.
• Supports continuous survey readiness programs to maintain strict compliance with regulatory standards.
• Develops strategic, collaborative relationships with government bodies, regulatory agencies, and external quality organizations to advance organizational interests.
• Forecasts the direction of future educational programs to raise awareness of changes in regulatory requirements and internal system usage.

Basic Qualifications & Requirements

• Master's degree in Business Administration, Health Care Administration, Nursing, Public Health, or a related field AND a minimum of eight years of experience in health care quality assurance/improvement; OR a Bachelor's degree in a related field AND a minimum of ten years of experience; OR a minimum of thirteen years of directly related experience.
• Minimum of eight years of experience in a clinical setting, health care administration, or a directly related field.
• Minimum of six years of experience in a leadership role managing direct reports.
• Minimum of four years of experience managing operational or project budgets.
• Minimum of two years of experience utilizing databases, spreadsheets, or continuous quality improvement (CQI) tools.
• Active Registered Professional Nurse (RN) License in the state of Georgia.
• Must possess experience as a quality leader within a large healthcare system or hospital setting, including both health plan and clinical experience.
• Extensive functional experience in credentialing, peer review, patient safety, risk management, and quality governance.
• Demonstrated experience managing CMS 5-Star ratings, HEDIS metrics, Joint Commission surveys, and NCQA outcomes.
• Requirement to obtain a Professional in Patient Safety Certificate, Professional Healthcare Quality Certificate, OR Professional in Healthcare Risk Management Certificate within 24 months of hire.