Director, Program Quality

Acentra Health, LLC

11h

About The Position

Acentra Health is looking for a Director, Program Quality to join our growing team. This position provides strategic and operational and regulatory leadership for the Imedecs quality program, including oversight of CMS Independent Dispute Resolution Entity (IDRE) and Independent Review Organization (IRO) programs, serving as the accountable quality authority for federally regulated dispute resolution and independent review functions under CMS. The Director role is responsible for end-to-end quality performance, regulatory compliance, audit outcomes and program integrity, with direct impact on contractual performance, financial risk, and client trust. This role operates with a high degree of autonomy and serves as a key liaison with CMS, clients, and accrediting bodies, ensuring alignment with evolving federal requirements and industry standards. Direct impact on federal program compliance and audit outcomes. Influences client satisfaction, contract retention and revenue protection. Responsible for quality performance across complex, high risk regulatory programs. Operates within a high-visibility externally scrutinized environment.

Requirements

Requires a bachelor’s degree (master’s degree preferred) from an accredited college or university
5+ years of management experience in a health-related field; or an equivalent combination of education and relevant experience
Demonstrated experience in vendor oversight, performance management, and cross-functional leadership in a regulated environment
Ability to take initiative, provide leadership, maintain confidentiality, meet deadlines and work in a collaborative team environment
Highly developed analytical skills with an ability to objectively evaluate data and perform statistical analysis
Strong leadership and stakeholder management skills with the ability to operate effectively in a matrixed environment while maintaining program ownership

Nice To Haves

Experience in healthcare quality, regulatory compliance, or review programs, with demonstrated exposure to CMS programs, IDRE, appeals, or dispute resolution environments preferred
Knowledge of URAC, NCQA, IRO standards, and CMS regulatory requirements strongly preferred
Experience with audit management, regulatory reporting, vendor oversite

Responsibilities

Owns quality strategy and execution for IDRE and IRO programs, ensuring alignment with CMS regulations, contractual obligations, and enterprise quality standards
Accountable for program-level quality outcomes, including accuracy, timeliness, audit performance and SLA adherence across high-volume, nationally regulated operations
Establishes and governs quality frameworks, KPIs and performance systems, including executive dashboards and reporting to senior leadership
Leads regulatory compliance and audit strategy, including CMS audits, client audits and accreditation reviews (URAC) with direct accountability for outcomes
Oversees quality assurance activities for IRO functions, including identification, escalation, and mitigation of compliance, operational, and reputational risks
Drives continuous improvement initiatives impacting operational efficiency, cost and performance with measurable impact on program success and margin
Provides executive level consultation to internal stakeholders on CMS regulatory requirements, IDRE processes, and quality performance implications
Oversees vendor and partner quality performance, ensuring alignment with contractual and regulatory expectations
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules