Director of Quality

CertifyOS

. Own quality standards across provider data quality and credentialing work quality .

Posted 10/15/2026full-timeRemote • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in quality management and compliance within healthcare operations, with a strong focus on NCQA standards, audit processes, and data-driven decision-making. Proven ability to lead teams, implement quality metrics, and drive improvements in credentialing workflows.

Highest-signal resume keywords

NCQA Standards ExpertiseQuality ManagementData-Driven Decision MakingAudit Function LeadershipCredentialing Process Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality Metrics DefinitionError Taxonomy DevelopmentRoot Cause AnalysisAudit Sampling MethodologyCredentialing File ReviewData AnalysisWorkflow EvaluationSystem Controls AssessmentPerformance TrackingCorrective Action Planning

Soft Skills

Strong CommunicationJudgmentLeadershipCollaborationAccountability

Tools & Technologies

BI DashboardsSQLWorkflow Analytics

Certifications & Qualifications

NCQA Certification

Industry Keywords

Healthcare OperationsComplianceCredentialingDelegated CredentialingCVOURACThe Joint CommissionCMSSOC 2HITRUST

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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