Director of Quality

Wellbe Senior Medical•Remote,

13h•Remote

About The Position

The Director of Quality is an execution-focused leader responsible for translating WellBe’s enterprise quality strategy into disciplined, measurable operations across markets and health plan contracts. This role leads the day-to-day Quality function, manages and develops team members, and redesigns care-gap closure workflows to be simpler, standardized, scalable, and integrated into clinical practice. The Director partners closely with market, clinical, pharmacy, analytics, technology, coding, and health plan stakeholders to improve HEDIS and Medicare Advantage Stars performance, strengthen data reliability, increase frontline accountability, and ensure quality insights are consistently converted into action. The position oversees quality operations across Part C and Part D, including care-gap workflows, HEDIS chart abstraction and validation, medical record retrieval, supplemental data submissions, medication adherence outreach, reporting, audits, and compliance with NCQA, HEDIS, CMS, Stars, and health plan requirements. The role operates in a corporate, primarily remote environment, with frequent collaboration across functions, markets, and external partners. Occasional local or national travel and schedule flexibility may be required. No routine on-call responsibilities are expected. This is a safety-sensitive position and requires full cognitive and physical functioning. Employment is contingent on required drug screening and background checks. WellBe does not offer employment-based visa sponsorship.

Requirements

Bachelor’s degree in nursing, healthcare administration, public health, health sciences, business, or a related field, or an equivalent combination of education and relevant experience.
Seven or more years of progressive experience in healthcare quality, managed care, provider operations, population health, HEDIS, or Medicare Advantage Stars.
Three to five years of people-management experience.
Demonstrated ability to set expectations, coach team members, manage performance, and deliver measurable operational results.
Experience mapping, redesigning, implementing, and sustaining complex workflows across multiple teams, markets, or contracts.
Strong working knowledge of NCQA HEDIS specifications, Medicare Advantage Stars, care-gap closure, medical record review, supplemental data, and quality operations.
Ability to move between strategy and execution, manage multiple priorities, remove barriers, and deliver results in a fast-paced, matrixed organization.
Strong people leadership, change-management, project-management, process-improvement, problem-solving, and written and verbal communication skills.
Advanced proficiency with Microsoft Excel and presentation tools.
High attention to detail, sound judgment, and ability to maintain confidentiality.
Ability to stand or sit for extended periods; visual acuity and fine motor ability.
Ability to travel locally or nationally as needed.
Must be legally authorized to work in the United States without current or future employer visa sponsorship.
Must successfully complete pre-employment drug screening and applicable background checks; continued employment is subject to applicable drug-free workplace and FACIS check requirements.
Must be able to perform job duties safely with full cognitive and physical functioning.

Nice To Haves

Experience with workflow platforms, reporting tools, automation, or AI-enabled healthcare solutions.

Responsibilities

Lead day-to-day execution of the Quality program across Part C and Part D, translating enterprise goals into workplans, ownership, timelines, operating rhythms, and measurable results.
Directly manage, coach, and performance-manage Quality team members, establishing productivity, quality, service, and accountability standards.
Map care-gap closure workflows across measures, markets, and health plan contracts; identify handoffs, rework, manual steps, failure points, and unnecessary variation.
Redesign and standardize workflows for care-gap identification, outreach, documentation, closure, submission, and reconciliation.
Engage markets through structured working sessions to diagnose barriers, assign actions, monitor commitments, and drive closure at patient, provider, measure, and market levels.
Partner with clinical operations and technology teams to surface prioritized care gaps at the point of care and embed closure activities into APP workflows.
Lead implementation and adoption of Quality workflow tools, including in-house technologies, point-of-care solutions, telephony or workforce-management tools, and future AI-enabled capabilities.
Oversee HEDIS chart abstraction, primary source validation, medical record retrieval, supplemental data submissions, and health plan audit support.
Manage medication adherence and other Part D outreach operations; use performance and workflow data to improve productivity, assess capacity, and inform staffing decisions.
Partner with analytics, IT, and health plan teams to strengthen WellBe-owned quality reporting using claims, EMR, pharmacy, and supplemental data, and reconcile data differences.
Use market-, provider-, measure-, and patient-level data to prioritize interventions, forecast performance, monitor outcomes, and adjust tactics when results are off track.
Evaluate and implement automation and AI-assisted solutions to reduce repetitive work, improve chart-review efficiency, and enable higher-value interventions and market partnership.
Own point-of-care solution assessment and implementation, including identifying operational pain points, coordinating vendors, planning rollouts, training users, supporting adoption, and monitoring performance.
Maintain current knowledge of NCQA, HEDIS, CMS, Stars, and applicable health plan requirements; ensure workflows, documentation, submissions, and controls remain compliant.
Build cross-functional relationships and drive decisions with clinical operations, pharmacy, coding, analytics, technology, finance, compliance, markets, and external vendors.