Director, Quality

Overview As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home. It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you? Showing Up Somatus Strong We foster an inclusive work environment that promotes collaboration and innovation at every level. Our values bring our mission to life and serve as the DNA for every decision we make : Authenticity : We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say. Collaboration : We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more. Empowerment : We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests. Innovation : We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions. Tenacity : We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners. Showing Up for You We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including : Subsidized, personal healthcare coverage (medical, dental vision) Flexible Paid Time Off (PTO) Professional Development, CEU, and Tuition Reimbursement Curated Wellness Benefits supporting teammates physical and mental well-being Community engagement opportunities And more! The Director of Quality, reporting to the AVP of Quality, is responsible for establishing, implementing, and overseeing an effective quality improvement program essential to meet NCQA requirements, state specific requirements, and CMS guidelines. This role provides guidance and oversight to all lines of business including Commercial, Medicaid, Medicare, and Special Need Plans (SNPs). The Director, Quality will work closely with Sr. Manager, Audit Risk and the Regulatory and Accreditation Team to ensure compliance with audits, complaints / grievances, and adherence to contractual obligations and Service Level Agreements to maintain high-quality standards and regulatory requirements. Responsibilities Essential Duties and Responsibilities : Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. Direct, implement, and monitor internal and external audit protocols to drive continuous quality improvement and ensure compliance with regulatory and organizational standards. Develop and execute the overall quality strategy aligned with organizational goals in conjunction with AVP / SVP. Maintain up to date knowledge of regulatory changes and ensure implementation across the organization, by facilitating cross-functional meetings when necessary. Monitor and leverage member feedback and satisfaction scores to enhance processes, procedures, and services and provide recommendations or action plan to other departments Ensure care management program aligns with evidence-based practices for CKD / ESKD members. Serve as a point of contact for escalation of issues requiring a higher degree of expertise or discretion to resolve and ensure timely resolution. Work with operations and management to develop strategic performance improvement plan and work plan goals for internal and external audits results. Champion initiatives such as Lean, Six Sigma, or other methodologies to enhance efficiency and reduce waste. Ensure compliance with applicable regulatory standards and service level agreements by overseeing the review and investigation of incident reports, complaints and grievances, and member and / or staff injuries to identify and develop improvement opportunities. Develop, track and report key quality performance indicators to measure the effectiveness of programs and identify improvement opportunities. Oversee information presented to committees as directed, such as, the Quality Committee, Clinical Enterprise Sub-Committee, Clinical Sub-Audit Committee, and Compliance Committee. Note : This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Qualifications Required Bachelor’s Degree in Nursing or other comparable healthcare field Three (3) years management in healthcare or risk management Five (5) years’ experience supporting healthcare executives and organizations Ten (10) years of hands-on operations experience in a healthcare environment Proven experience in Quality Management and Leadership roles Extensive experience in quality management within a healthcare or chronic disease management setting, preferably in kidney care Experience in structuring and executing complex analyses to support strategy in a fast-paced, evolving environment Familiarity with CMS programs and NCQA accreditation survey experience, including submission of documents to accreditation agency Preferred Master’s degree in Business Administration or related advanced degree Associate of Risk Management (ARM) and / or Certified Professional in Health Care Risk Management 3 years Infection Control & Prevention experience Knowledge, Skills, and Abilities : Intermediate knowledge of local, state, and federal laws and regulations pertaining to Medicaid guidelines Strong understanding of quality tools and methodologies (e.g. Six Sigma, Lean, RCA) Ability to document and analyze complex business requirements Ability to interface with Senior Level Executives during client meetings Must be a proactive, hands-on leader with a strategic vision and accountability Strong financial and data acumen – detail oriented, budget management Ability to give and receive feedback and constructive criticism Ability to be both a strategic and tactical change agent in healthcare Self-starter who takes initiative in a fast-paced environment Strategic solution-seeker who sees opportunities Strong interpersonal skills and ability to communicate effectively, including verbal and written skills Ability to create compelling and dynamic presentations Ability to handle ambiguity and work in a fast-paced start-up Other Duties Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Somatus, Inc. provides equal employment opportunity to all individuals regardless of race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by law. Discrimination of any type will not be tolerated. J-18808-Ljbffraa415a4b-8b21-40fc-a65c-70d2b25ca29a