Director, Health Plan Quality Program Management & Performance (Texas Health Plan)

Accountabilities:: Lead and direct the team responsible for health plan quality management and performance improvement activities, ensuring alignment with state, federal, and NCQA requirements. Develop and implement quality program management strategies, including surveys, audits, performance improvement initiatives, and other regulatory activities. Oversee quality program activities and performance management to maintain compliance with applicable health plan contracts, regulations, policies, and quality standards. Represent senior leadership at internal national and regional meetings and serve as a subject matter expert during state-level meetings and quality-related engagements. Oversee the development and completion of effective Performance Improvement Projects (PIPs), using quality improvement methodologies to drive measurable results. Collaborate with analytics and strategic teams to evaluate quality performance management activities, interpret results, and communicate findings to leadership. Maintain quality program structures and processes, including policies and procedures, committee and workgroup governance, document management, reporting, and tracking of key deliverables. Prepare clear written reports and documentation that capture quality activities, member and provider feedback, outcomes, interventions, and remeasurement results. Ensure policies and procedures remain current with evolving state, federal, NCQA, and health plan requirements, including state-specific policy updates. Lead training and education initiatives for quality management and performance staff to ensure understanding of regulatory requirements, workflows, policies, and contractual obligations. Establish ongoing tracking and trending of quality requirements, operational KPIs, process reviews, and gap analyses to identify opportunities for improvement. Apply quality improvement methodologies such as the Plan-Do-Study-Act (PDSA) cycle to support individual, team, and organizational process improvement. Hire, develop, coach, and manage team members while maintaining accountability for team performance and department-specific quality goals. Travel to local or regional project sites approximately 0–50% of the time for same-day business activities and up to 0–20% of the time for overnight travel, depending on health plan and state-specific requirements. Requirements: At least 8 years of healthcare experience, including a minimum of 5 years in health plan quality improvement, or an equivalent combination of relevant education and experience. At least 3 years of management or leadership experience. Advanced knowledge of HEDIS and NCQA requirements, standards, and quality program practices. Experience with HEDIS reporting and data collection, CAHPS improvement initiatives, and state quality improvement programs. Experience working with government-sponsored healthcare programs, including Medicaid, Medicare, and Marketplace programs. Understanding of NCQA standards, including experience interpreting requirements and applying them to health plan operations. Experience supporting or leading NCQA accreditation surveys and audits, as well as audits focused on state contracts and regulatory compliance. Experience with Performance Improvement Projects and continuous quality improvement methodologies. Knowledge and experience related to EPSDT and/or Texas Health Steps programs is preferred. Strong data analysis, manipulation, interpretation, reporting, and data-driven decision-making capabilities. Excellent critical-thinking, problem-solving, analytical, organizational, and project management skills. Strong business writing skills and excellent verbal and written communication abilities. Demonstrated ability to implement process improvement initiatives, drive organizational change, and manage significant cross-functional work. Ability to work independently in a fast-paced, deadline-driven environment and effectively operate within a highly matrixed organization. Strong proficiency with Microsoft Office, including Excel, as well as the ability to learn and use new information systems and software. Experience with provider credentialing and subcontractor monitoring is preferred. CPHQ or CHCA certification is preferred. Registered Nurse (RN) qualification is preferred; if licensed, the license must be active and unrestricted in the state of practice. Clinical licensure or certification may be required where mandated by state contract, regulation, business operating model, or applicable licensing requirements. Benefits: Competitive compensation and benefits package. Opportunity to lead health plan quality management and performance improvement initiatives with significant organizational and member impact. Leadership responsibility for a specialized quality management and performance team. Exposure to complex state, federal, and NCQA quality programs and regulatory requirements. Cross-functional collaboration with analytics, strategy, clinical, operational, and senior leadership teams. Opportunities to drive data-informed process improvements and continuous quality initiatives. Same-day and overnight travel requirements may vary based on health plan and state-specific needs. Additional healthcare, retirement, paid time off, and other benefit details were not specified in the source job description.