Director of Quality

🕒 Outubro 15

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

👻 Score fantasma 10%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 29 dias.
• As vagas desta empresa costumam ser preenchidas em 48 dias.
• Sem salário divulgado.

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CertifyOS

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2021

🏥 Saúde

☁️ SaaS

🤝 B2B

💰 $40.000.000 Series B - Certify em 2025-06

Healthcare • SaaS • B2B

A CertifyOS é uma plataforma de dados de provedores focada em saúde que consolida e verifica informações de provedores para criar uma fonte única de verdade habilitada por IA. Ela substitui planilhas e soluções pontuais por infraestrutura para credenciamento, contratação, pagamentos, conformidade e gerenciamento de dados de provedores, oferecendo serviços como credenciamento, licenciamento, monitoramento e gestão de listas. A plataforma ingere listas e feeds em tempo real, valida registros contra milhares de fontes e fornece um fluxo contínuo de dados limpos acessíveis via uma única API. A CertifyOS se posiciona como uma solução SaaS B2B para planos de saúde, empresas de saúde digital e sistemas de saúde, reivindicando melhorias operacionais mensuráveis (por exemplo, redução de custos de recredenciamento, integração mais rápida) e listando grandes planos de saúde entre seus clientes.

Descrição

• Own quality standards across provider data quality and credentialing work quality • Define quality metrics, error taxonomies, baselines, and targets by client, workflow, and team • Report quality metrics to leadership and clients • Identify error origins, high-risk clients and workflows, and high-impact fixes • Build a culture of quality across Operations through standards, feedback, and accountability • Lead and grow a central quality team conducting internal audits of credentialing files and processes • Improve audit sampling methodology, scoring, error taxonomy, calibration, reporting, coverage, consistency, and cost per audit • Translate audit findings into root causes and product or automation changes • Collaborate with Product, Engineering, and Data on requirements, prioritization, validation, and follow-up audits • Manage daily audit throughput and turnaround time through capacity planning, work allocation, and staffing • Run dashboards, daily and weekly operating cadences, and escalation paths • Hire, develop, and maintain a high performance bar for auditors and team leads • Own CertifyOS's NCQA certification posture, including readiness, evidence, survey preparation, and remediation • Interpret NCQA standards and translate them into testable requirements for credentialing operations and the platform • Monitor NCQA standards, client-specific requirements, and regulatory changes • Implement new requirements through SOP updates, training, checklists, and system configuration • Verify post-launch adherence in practice • Own delegation programs with health plan clients, including agreements, oversight schedules, and delegation audits • Track delegated-function performance and lead corrective action plans through closure • Serve as senior compliance and quality voice with client stakeholders and credentialing committee leaders

🎯 Requisitos

• Genuine obsession with quality in data, work, and outcomes • Record of driving quality at scale, including building measurement, audit, and feedback systems that reduced error rates • Strongly data-driven; able to find root causes with data, design sampling and scoring, build and use dashboards, and make decisions based on numbers • Deep credentialing expertise, including provider file creation, verification, committee review, primary source verification, recredentialing cycles, and common failure modes • Experience running an audit or QA function at production scale, including sampling, scoring, calibration, and root cause analysis • Technical fluency sufficient to read workflows, write clear requirements, and evaluate automation and system controls • 10+ years in healthcare operations, quality, or compliance • 5+ years leading teams, with direct ownership of throughput and turnaround-time targets • Hands-on knowledge of NCQA credentialing standards and how they are audited • Experience with delegation from either side: overseeing delegates at a health plan or being overseen as a delegated credentialing organization or CVO • Executive presence with health plan compliance officers and senior client leaders • Strong written and verbal communication • Judgment to escalate the right issues early • Nice to have: experience at a CVO, delegated health plan credentialing department, or credentialing technology company • Nice to have: NCQA experience beyond credentialing • Nice to have: familiarity with URAC, The Joint Commission, CMS, state credentialing requirements, SOC 2, or HITRUST audits • Nice to have: experience with SQL, BI dashboards, or workflow analytics • Nice to have: experience in a scaling startup

🏖️ Benefícios

• 100% coverage of health, dental, and vision insurance premiums for employees • Unlimited PTO for US-based team members, with at least two weeks off each year to recharge • Health insurance for employees in India • Statutory leave benefits for employees in India • Additional wellness (menstrual) leave for women in India • Equal employment opportunity and inclusive work environment • Reasonable accommodations during the application process

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