Director of Quality

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 12%

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CertifyOS

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2021

🏥 Healthcare

☁️ SaaS

🤝 B2B

💰 $40M Series B - Certify on 2025-06

Healthcare • SaaS • B2B

CertifyOS is a healthcare-focused provider data platform that consolidates and verifies provider information to create a single, AI-enabled source of truth. It replaces spreadsheets and point solutions with infrastructure for credentialing, contracting, payments, compliance, and provider data management, offering services like credentialing, licensing, monitoring, and roster management. The platform ingests rosters and real-time feeds, validates records against thousands of sources, and delivers a continuous, clean data stream accessible via one API. CertifyOS is positioned as a B2B SaaS solution for health plans, digital health companies, and health systems, claiming measurable operational improvements (e. g. , reduced re-credentialing costs, faster onboarding) and listing major health plans among its clients.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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