Director, Clinical Quality, Training, Oversight and Innovation
Core
Leading enterprise-wide clinical quality assurance, training, and innovation to ensure compliance with healthcare standards and support product strategy.
Role type
Senior Clinical Quality Director (Healthcare Data & AI)
Builds
Clinical quality management services, reporting mechanisms, and clinical product implementations for healthcare plans and public programs.
Domain
Healthcare / Health Insurance / Risk Adjustment / AI in Medicine
Deliverable
production ML models | dashboards & analysis | client delivery
Required skills
ICD-10 diagnosis coding, HEDIS quality measures, risk adjustment coding, AI tools understanding, clinical nursing background, healthcare plan quality improvement, public programs knowledge
Preferred skills
Strategic process development, cross-functional team leadership, client relationship management
Technologies
AI tools, HEDIS reporting systems, clinical management platforms
Responsibilities
Develop and implement companywide quality improvement efforts; monitor quality and reliability of reporting mechanisms; perform analysis of reviews for senior leadership; ensure compliance with quality standards; support clinical product strategy through research and development; execute training processes; manage internal and client-facing clinical auditing programs; develop new policies and procedures.
Seniority
Senior, hands-on IC with strategic oversight