Director of Quality

Job Summary

Position Summary

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 the organization consistently converts quality insights into action.

Job Description

Essential Duties and ResponsibilitiesLead day-to-day execution of the Quality program across Part C and Part D, converting enterprise goals into clear workplans, owners, timelines, operating rhythms, and measurable results.Directly manage, coach, and performance-manage Quality team members; establish clear productivity, quality, service, and accountability standards.Map end-to-end 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 so care-gap identification, outreach, documentation, closure, submission, and reconciliation are consistently executed and sustainable at scale.Engage Markets using structured working sessions that diagnose barriers, assign actions, monitor commitments, and drive closure at the 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, with an emphasis on accuracy, timeliness, and reduced manual effort.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; reconcile numerator, denominator, timing, and data-integrity differences.Use market-, provider-, measure-, and patient-level data to prioritize interventions, forecast performance, monitor outcomes, and adjust tactics quickly when results are off track.Evaluate and implement practical automation and AI-assisted solutions that reduce repetitive work, improve chart-review efficiency, and allow the team to focus on higher-value intervention and market partnership.Own point-of-care solution assessment and implementation, including identification of operational pain points, vendor coordination, rollout planning, training, adoption, and performance monitoring.Maintain current knowledge of NCQA, HEDIS, CMS, Stars, and applicable health plan requirements; ensure workflows, documentation, submissions, and controls remain compliant.Build effective cross-functional relationships and drive decisions with stakeholders across clinical operations, pharmacy, coding, analytics, technology, finance, compliance, markets, and external vendors.

Job Requirements

Required Qualifications

Education: 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.

Experience: Seven or more years of progressive experience in healthcare quality, managed care, provider operations, population health, HEDIS, or Medicare Advantage Stars, including 3–5 years of people-management experience. Demonstrated experience setting expectations, coaching team members, managing performance, delivering measurable operational results, and mapping, redesigning, implementing, and sustaining complex workflows across multiple teams, markets, or contracts.

Skills: Strong working knowledge of NCQA HEDIS specifications, Medicare Advantage Stars, care-gap closure, medical record review, supplemental data, and quality operations. Proven 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; experience with workflow platforms, reporting tools, automation, or AI-enabled healthcare solutions preferred. High attention to detail, sound judgment, and the ability to maintain confidentiality.

Physical and Mental Requirements

• Ability to stand or sit for extended periods.

• Visual acuity and fine motor.

• Ability to travel locally or nationally as needed.

Work Environment

This role operates in a corporate, primarily remote environment and requires frequent collaboration across functions, markets, and external partners. Occasional travel and schedule flexibility may be required to support market operations, implementations, audits, and business priorities. No routine on-call responsibilities are expected.

Sponsorship Statement

WellBe does not offer employment-based visa sponsorship for this position. Applicants must be legally authorized to work in the United States without the need for employer sponsorship now or in the future.

Pay Transparency Statement

Compensation for this position will be disclosed in accordance with applicable state and local pay transparency laws.

Safety-Sensitive Statement

This position has been designated as safety-sensitive. As such, the employee must be able to perform job duties in a manner that ensures the safety of themselves, coworkers, patients, and the public. The role requires full cognitive and physical functioning at all times.

Employees in safety-sensitive positions are subject to drug and alcohol testing, including for substances that may impair judgment or motor function, in accordance with applicable federal and state laws and company policy. Due to the safety-sensitive nature of this role and in alignment with federal law and workplace safety standards, the use of marijuana—including medical or recreational use—is prohibited. WellBe Senior Medical will comply with applicable state laws regarding medical marijuana and reasonable accommodations, where such laws do not conflict with safety requirements or federal regulations.

Drug Screening Requirement

As a condition of employment, WellBe Senior Medical requires all candidates to successfully complete a pre-employment drug screening. Ongoing employment may also be contingent upon compliance with the company’s Drug-Free Workplace Policy, which includes random, post-accident, and reasonable suspicion drug testing. The company reserves the right to test for substances that may impair an employee’s ability to safely and effectively perform their job duties.

Background Check Statement

Employment is contingent upon successful completion of a background check, as permitted by law. As a healthcare organization, WellBe conducts monthly FACIS (Fraud and Abuse Control Information System) checks on all employees. Continued employment is contingent upon satisfactory results of these checks, in accordance with applicable laws and regulations.

Equal Employment Opportunity (EEO) Statement

WellBe is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected status.

Americans with Disabilities Act

WellBe Senior Medical is committed to complying with the Americans with Disabilities Act (ADA) and applicable state and local laws. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the job. If you require an accommodation during the application, interview or employment process, please contact Human Resources at [email protected]

At-Will Employment Statement

Employment with WellBe is at-will unless otherwise specified by contract. This job description does not constitute an employment contract.

Disclaimer

This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.