Job Details

The Director of Quality Improvement and Performance supports the Vice President of Quality in overseeing and executing key quality initiatives across all lines of business. This role provides leadership for quality improvement operations, regulatory program performance, and member centered quality strategies. The Director collaborates with cross functional leaders, manages Quality staff, and ensures programs are aligned with organizational goals, regulatory requirements, and evidence based best practices.

The Director plays a critical role in advancing continuous quality improvement, operational efficiency, and performance excellence. This position also contributes to the organization's goals in Medicare Stars, NCQA, Medicaid quality programs, and other state and federal performance initiatives.

Job Description

Summary
The Director of Quality Improvement and Performance supports the Vice President of Quality in overseeing and executing key quality initiatives across all lines of business. This role provides leadership for quality improvement operations, regulatory program performance, and member centered quality strategies. The Director collaborates with cross functional leaders, manages Quality staff, and ensures programs are aligned with organizational goals, regulatory requirements, and evidence based best practices. The Director plays a critical role in advancing continuous quality improvement, operational efficiency, and performance excellence. This position also contributes to the organization's goals in Medicare Stars, NCQA, Medicaid quality programs, and other state and federal performance initiatives.

Job Duties

• Quality Leadership & Strategy Support the VP of Quality in implementing the organization’s quality vision and strategic priorities. Lead day to day quality operations, ensuring alignment with organizational objectives, regulatory requirements, and member focused improvement goals. Promote a culture of continuous improvement, accountability, and high performance across the Quality Improvement and Performance team. Apply evidence based methodologies to enhance clinical quality, patient safety, service delivery, and member satisfaction.
• Program Oversight & Performance Improvement Oversee the execution of quality work plans, ensuring timely completion, accurate documentation, and effective interventions. Monitor quality metrics, identify performance gaps, and develop targeted improvement plans. Support Medicare Stars, NCQA, Medicaid HEDIS, and state program initiatives by ensuring program readiness, reporting accuracy, and operational alignment.
• Data, Analytics & Reporting Use analytics to identify trends, risk areas, and improvement opportunities; translate insights into actionable strategies. Oversee the accuracy and integrity of quality data and reporting processes. Support the preparation of reports for executive leadership, regulatory bodies, and quality committees.
• Collaboration & Stakeholder Engagement Work cross functionally with Clinical Services, Community Engagement, Population Health, Provider Relations, Customer Experience, IT/Analytics, and external partners to drive performance improvements. Communicate quality results, trends, and opportunities through reports, presentations, and committee participation. Represent the Quality Improvement and Performance department in internal committees and select external stakeholder engagements.
• Team Development & Supervision Provide leadership, coaching, and professional development to Quality Managers, Analysts, and Program Coordinators. Maintain a positive work environment that supports collaboration, learning, and staff empowerment. Ensure workload distribution, performance management, and staff accountability for key deliverables.
• Regulatory Oversight & Compliance Ensure compliance with Medicare, Medicaid, NCQA, and other regulatory/accreditation standards. Stay current on regulatory changes and support organizational readiness for audits and surveys.

Minimum Qualifications

• Bachelor’s Degree n healthcare administration, public health, business, or related field
• 7 years experience in Quality Improvement and Performance, Clinical Quality, Managed Care, or related fields. and
• 3 years years experience in a supervisory or leadership role.
• Experience with Medicare Stars, Medicaid HEDIS, NCQA, or similar programs
• Strong skills in data analysis.
• Proficiency in data analytics tools and PC-based applications (Excel, Access, Word).
• Experience leading cross-functional improvement initiatives

Preferred Qualifications

• Master’s Degree in healthcare administration, public health, business, or related field

Additional Qualifications

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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