Director of Clinical Operations, Quality & Performance Programs

Fuze Health

2d•$172,000 - $215,000•Remote

About The Position

At Fuze Health, we put patients first and tirelessly address the most pressing needs in healthcare. We empower millions to digitally connect with care providers, essential health resources and needed treatments – and enable care providers, employers, health plans and life sciences companies to meaningfully enhance quality, outcomes and value. We are dedicated to helping our partners evolve and modernize to meet emerging patient and marketplace needs. Fuze Health’s foundation is built upon the strategic combination of several proven, technology-powered innovators in the digital health, diagnostics, and pharmacy sectors. Our growing portfolio brings together the capabilities of industry leaders including LetsGetChecked, Truepill, and Alto Pharmacy, to create a distinctive, unified force in healthcare. Together, we have the shared vision, advanced capabilities and talented teams to deliver next-generation solutions that patients and healthcare partners need today and into the future. The Director, Quality & Performance Programs drives strategic and operational excellence across healthcare quality programs, clinical data systems, contact center operations, and external client partnerships. Acting as the central leader for quality program performance, this role translates complex clinical and quality requirements into scalable strategies, workflows, and operating models that improve outcomes, close gaps in care, and deliver measurable value for clients. You will lead and develop high-performing teams while overseeing the execution and continuous optimization of complex, high-volume programs, ensuring operational readiness to navigate volume spikes, evolving program requirements, and time-sensitive performance goals. Partnering dynamically across clinical, operations, data, technology, and client-facing teams, you will leverage performance analytics, quality metrics, and actionable insights to drive accountability, strengthen client relationships, identify opportunities for improvement, and build scalable programs that consistently deliver exceptional quality and performance outcomes.

Requirements

5+ years of direct experience in healthcare quality operations, with a strong focus on Medicare STARS program metrics, HEDIS reporting, or risk adjustment.
Strong, foundational knowledge of NCQA guidelines, HEDIS specifications, and Medicare Star Ratings.
Direct experience using Looker (or similar business intelligence tools) to track key performance indicators (KPIs), monitor throughput, and make data-driven staffing decisions.
Practical, hands-on experience navigating major EMR platforms and cloud-based contact center telephony platforms.
High proficiency in G Suite / Google Workspace (Docs, Sheets, Slides, Drive) to create client presentations, manage operational trackers, and facilitate meetings.
Demonstrated ability to project staffing needs and scale personnel dynamically based on data throughput during peak HEDIS seasons.

Nice To Haves

2+ years of experience in a client-facing role, managing corporate healthcare clients, payers, or enterprise accounts.
Deep experience managing end-to-end measure closures and executing targeted interventions to boost performance.
Experience assisting with or designing strategic initiatives to achieve and maintain the ratings.
Exceptional communication skills with the ability to translate complex operational data into clear, actionable updates for executive leadership and clients.
Proven track record of managing third-party vendor contracts and rapidly scaling temporary contractor workforces during seasonal ramp-up periods.

Responsibilities

Drive the strategy and execution for closing clinical quality gaps (STARS/HEDIS), ensuring maximum accuracy, compliance, and throughput.
Develop complex staffing models based on historical and real-time throughput data to ensure optimal staffing levels during peak seasons.
Rapidly scale and ramp up team size, technology, and workflows to successfully manage sudden volume surges and intake spikes.
Facilitate critical operational reviews, including Daily Syncs, Weekly Business Reviews (WBRs), and Monthly Business Reviews (MBRs), to keep stakeholders aligned.
Act as the primary operational point of contact for clients, delivering high-impact presentations and managing expectations with transparency.
Lead preparation efforts for rigorous external and client-led audits.
Conduct and facilitate joint client call-listening sessions to monitor agent quality, align on compliance guidelines, and refine training protocols.
Leverage a deep understanding of telephony setups (IVR, dialer strategies) and Electronic Medical Record (EMR) systems to streamline workflows and improve data retrieval speeds.
Manage third-party contractors and vendors, holding them accountable to strict service level agreements (SLAs) and budget parameters.

Benefits

dental
vision
multiple group medical plans to choose from
a 401(k) retirement savings plan
group life insurance
accidental death and dismemberment (AD&D) insurance
flexible spending account (FSA)
health savings account (HSA)
commuter benefits
employer-paid short-term (STD) and long-term disability (LTD) insurance
additional supplemental insurance plans (spouse life insurance, legal insurance, an employee assistance program, home health testing kits, and a fertility medication discount program)
flexible vacation time
accrued paid sick time
10 paid holidays
(2 floating holidays for full time non-exempt employees)
eight weeks of paid parental leave for eligible employees
additional paid weeks for the birthing parent
4 weeks paid caregiver leave
a Lifestyle Spending Account allowance each month