Director of Quality

🕒 vor 26 Tagen

🇺🇸 Vereinigte Staaten – Remote

⏰ Vollzeit

🔴 Experte

👔 Direktor

👻 Geisterscore 10%

Was es bedeutet: die Wahrscheinlichkeit, dass für diese Stelle niemand wirklich einstellt.So liest du es: 60 % oder höher heißt, wir halten das für einen Geisterjob. Niedrigere Werte sind weniger bedenklich.Warum dieser Wert:

• Seit 27 Tagen offen.
• Stellen bei diesem Unternehmen werden meist in 48 Tagen besetzt.
• Kein Gehalt angegeben.

Jetzt Bewerben

Ähnliche Remote-Jobs finden

CertifyOS

WebsiteLinkedInAlle Stellen

201 - 500 Mitarbeiter

Gegründet 2021

🏥 Gesundheitswesen

☁️ SaaS

🤝 B2B

💰 €40.000.000 Series B - Certify im 2025-06

Healthcare • SaaS • B2B

CertifyOS ist eine auf das Gesundheitswesen fokussierte Plattform für Anbieterdaten, die Informationen zu Anbietern konsolidiert und verifiziert, um eine einzige, KI-gestützte Wahrheitsquelle zu schaffen. Es ersetzt Tabellenkalkulationen und punktuelle Lösungen durch eine Infrastruktur für Akkreditierung, Vertragsgestaltung, Zahlungen, Compliance und Anbieterdatenmanagement. Die angebotenen Dienste umfassen Akkreditierung, Lizenzierung, Überwachung und Listenverwaltung. Die Plattform integriert Listen und Echtzeit-Feeds, validiert Datensätze gegen Tausende von Quellen und liefert einen kontinuierlichen, sauberen Datenstrom, der über eine API zugänglich ist. CertifyOS ist als B2B-SaaS-Lösung für Krankenversicherungen, digitale Gesundheitsunternehmen und Gesundheitssysteme positioniert und bietet messbare betriebliche Verbesserungen (z. B. reduzierte Kosten für die Neuausstellung von Zeugnisse, schnellere Einarbeitung) und hat große Krankenversicherungen als Kunden gelistet.

Beschreibung

• 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

🎯 Anforderungen

• 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

🏖️ Vorteile

• 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

📊 Überprüfen Sie Ihre Lebenslauf-Bewertung für diese Stelle

Verbessern Sie Ihre Chancen auf ein Vorstellungsgespräch, indem Sie Ihre Lebenslauf-Bewertung vor der Bewerbung überprüfen.

Lebenslauf hochladen