Senior Director, Clinical Training & Quality
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior Director providing leadership for clinical quality oversight and training across a national Medicare Advantage health plan. Developing audit functions, training programs, and performance improvements.
Responsibilities:
- Provide enterprise leadership for internal clinical quality oversight, performance monitoring, and workforce training across a national Medicare Advantage health plan
- Build and lead an internal clinical quality audit function focused on evaluating employee performance, clinical decision-making, documentation, and adherence to policies and workflows
- Establish audit methodologies, sampling approaches, scoring criteria, and reporting standards to assess quality and consistency of internal clinical work
- Conduct routine and targeted audits across clinical and operational roles (e.g., care management, utilization management, clinical reviews)
- Identify performance gaps, patterns of non-adherence, and operational risks; perform root cause analyses to distinguish training, process, and system issues
- Develop, implement, and oversee corrective action plans (CAPs) tied to audit findings, including retraining, workflow changes, and performance monitoring
- Track corrective action effectiveness and ensure sustained improvement through follow-up audits and trend analysis
- Own the enterprise clinical quality training strategy aligned to audit findings, regulatory requirements, and operational priorities
- Design and implement role-based, competency-driven training programs that translate clinical standards and policies into practical, repeatable execution
- Lead development of standardized curricula, onboarding programs, refresher training, job aids, and performance support tools
- Ensure training programs are embedded into day-to-day operations and reinforced through leadership coaching and performance management
- Partner with Learning & Development to leverage adult learning principles, delivery modalities, and learning management systems
- Integrate audit results and training outcomes into a continuous feedback loop to drive performance improvement
- Collaborate with Clinical Operations, Compliance, Human Resources, and Analytics teams to align performance monitoring, training, and corrective action efforts
- Present audit findings, performance trends, and improvement plans to senior leadership
- Define success metrics for audit performance, training effectiveness, and corrective action outcomes
- Develop dashboards and reporting to monitor trends, risks, and improvement over time
- Lead, mentor, and develop a team of quality auditors, trainers, and clinical subject matter experts
Requirements:
- 10+ years of experience in clinical quality, healthcare operations, or performance management within Medicare Advantage or managed care
- Demonstrated experience auditing internal clinical or operational performance and leading corrective action efforts
- Proven success designing and implementing large-scale training programs tied to performance outcomes
- Strong understanding of Medicare Advantage regulations and internal quality oversight expectations
- Bachelor's degree required; advanced degree in Nursing, Public Health, Healthcare Administration, or related field preferred
- Active clinical license (e.g., RN, NP, PA, MD/DO) preferred
- Experience building internal quality monitoring or workforce performance programs
- Background in care management, utilization management, or clinical operations
- Familiarity with adult learning theory, coaching models, and performance remediation
- Experience working in highly regulated healthcare environments
Benefits:
- Health insurance
- 401(k) retirement plans
Similar Jobs
Director CDx Development
Director of Companion Diagnostics at BeOne developing integrated diagnostic strategies for clinical programs. Collaborating with research and regulatory teams to ensure successful diagnostics development.
Associate Director – External Manufacturing
Associate Director supporting drug substance manufacture within External Manufacturing Network at a leading healthcare company. Driving technical leadership and ensuring compliance in manufacturing processes through collaboration.
Strategic Program Delivery Director
Strategic Program Delivery Director overseeing portfolio delivery and governance initiatives for Assurant's transformation efforts. Leading cross-functional teams in executing strategic priorities and delivering measurable outcomes.
Director, Payment Integrity
Director overseeing payment integrity processes and compliance in the healthcare sector for Centene. Leading audit programs and training initiatives to reduce waste and fraud.
Director, Post Breach Recovery – IR
Director Cybersecurity leading post-breach recovery engagements for a global cyber-attack response organization. Technical leadership during high-pressure cyber incidents to restore business operations.
Director of Implementation Services
Director of Implementation Services managing ERP implementations for healthcare organizations. Overseeing complex projects within a dynamic remote team in North America.
Director, Commercial Special Servicing
Director overseeing Special Servicing of defaulted commercial real estate loans at PHH. Leading a team and managing lender relations, policy revisions, and strategic planning.
Channel Director
Channel Director managing partner relationships and enablement across APAC markets to drive revenue. Collaborating with teams to align partner activities with company strategy across the sales group.
Director, IKC Clinical Programs
Director of IKC Clinical Programs leading value-based healthcare initiatives at DaVita, overseeing strategic plan execution and innovative care interventions for IKC patients.
Director, Revenue Initiatives
Director of Revenue Initiatives at Solera leading strategic revenue projects for enhancing sales performance and revenue predictability. Collaborating with cross-functional teams for operational effectiveness.
Director, Media Platform Development
Director of Media Platform Development leading software development for Unlock Health's media operations. Overseeing a hybrid team and implementing advanced media tools for campaign management.
Director, US Commercial Education – Electrophysiology
Leading US Commercial learning strategy for Electrophysiology at Johnson & Johnson MedTech. Overseeing training programs for the sales organization and collaborating with senior leadership.
Patient Experience Director
Patient Experience Director at Carrum Health focusing on enhancing the gold standard of healthcare experience. Leading patient journey efforts across care, product, tech, and marketing teams.
Director, IT
Director of IT at Upsun, managing secure systems for a distributed team. Fostering operational excellence and leading IT initiatives within a cloud application platform.
Director, IT
Director, IT at Upsun ensuring secure and efficient technology operations for a global workforce. Collaborating cross-functionally while refining infrastructure processes and managing access tools.
Regional Director
Sales Regional Director driving commercial strategy in the Centre/West region for a growing medical technology company. Leading teams and developing client relationships to enhance business outcomes.
Director, Industry Advisor – Student Information Systems
Industry Advisor supporting Student Information Systems at Salesforce. Leveraging expertise to drive education transformation through innovative cloud technologies and strategic market initiatives.
Associate Director, Thought Leader Liaison
Lead a team of Thought Leader Liaisons expanding strategic relationships with KOLs for Amgen. Drive business strategies and elevate KOL engagement across the organization.
Regional Business Director – West
Regional Business Director responsible for driving launch excellence and regional revenue at CG Oncology. Leading a high-performing team to deliver regional sales objectives for bladder cancer therapies.
Regional Business Director – Southwest
Regional Business Director driving launch excellence for Cretostimogene at CG Oncology. Leading commercialization efforts and high-performing team to achieve sales objectives in the Southwest region.