Director of Clinical Operations, Quality & Performance Programs

🔥 14 hours ago

🏈 Alabama, Arizona, +33 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $172k - $215k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 7%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Fuze Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

☁️ SaaS

💊 Pharmaceuticals

Healthcare • SaaS • Pharmaceuticals

Fuze Health is a technology-led healthcare company that provides integrated pharmacy solutions, clinical services, and data-driven software to healthcare organizations, payers, employers, and life sciences partners. Through its FuzeRx digital pharmacy, Fuze Services clinical programs, and Fuze Technologies platform, it delivers API-powered prescription fulfillment, telehealth, diagnostics and genomics, patient engagement, and analytics to improve access, adherence, early identification of conditions, and outcomes at scale.

📋 Description

• Drive strategy and execution for closing clinical quality gaps, including STARS/HEDIS measures • Develop complex staffing models using historical and real-time throughput data • Rapidly scale teams, technology, and workflows for volume surges and intake spikes • Facilitate Daily Syncs, Weekly Business Reviews, and Monthly Business Reviews • Serve as primary operational point of contact for clients • Deliver high-impact client presentations and manage expectations transparently • Lead preparation for external and client-led quality and compliance audits • Conduct and facilitate joint client call-listening sessions • Monitor agent quality, align compliance guidelines, and refine training protocols • Oversee telephony setups, including IVR and dialer strategies, and EMR systems • Streamline workflows and improve data retrieval speeds • Manage third-party contractors and vendors against SLAs and budget parameters • Lead and develop high-performing teams • Partner across clinical, operations, data, technology, and client-facing teams • Use performance analytics, quality metrics, and actionable insights to drive accountability and improve outcomes

🎯 Requirements

• 5+ years of direct experience in healthcare quality operations, focused on Medicare STARS program metrics, HEDIS reporting, or risk adjustment • Strong foundational knowledge of NCQA guidelines, HEDIS specifications, and Medicare Star Ratings • Direct experience using Looker or similar business intelligence tools • Hands-on experience navigating major EMR platforms and cloud-based contact center telephony platforms • High proficiency in G Suite / Google Workspace, including Docs, Sheets, Slides, and Drive • Ability to project staffing needs and dynamically scale personnel based on data throughput during peak HEDIS seasons • 2+ years of client-facing experience managing corporate healthcare clients, payers, or enterprise accounts (preferred) • Experience managing end-to-end measure closures and executing targeted interventions (preferred) • Experience assisting with or designing strategic STARS initiatives (preferred) • Exceptional communication skills for translating complex operational data into actionable executive and client updates (preferred) • Experience managing third-party vendor contracts and rapidly scaling temporary contractor workforces (preferred) • Ability to work at a computer terminal for extended periods and perform the stated physical requirements • Applicants must be authorized to work for any employer in the U.S.

🏖️ Benefits

• Dental, vision, and multiple group medical plans • 401(k) retirement savings plan • Group life insurance • Accidental death and dismemberment (AD&D) insurance • Flexible spending account (FSA) and health savings account (HSA) • Commuter benefits • Employer-paid short-term (STD) and long-term disability (LTD) insurance • Supplemental insurance plans, including spouse life insurance and legal insurance • Employee assistance program • Home health testing kits • Fertility medication discount program • Flexible vacation time • Accrued paid sick time • 10 paid holidays • 2 floating holidays for full time non-exempt employees • Eight weeks of paid parental leave for eligible employees, with additional paid weeks for the birthing parent • 4 weeks paid caregiver leave • Lifestyle Spending Account allowance each month • Travel required up to 5% of the time