Director Ambulatory Quality & Regulator Compliance

Tallahassee Memorial HealthCare; Tallahassee (FL); Presencial; USD 120.000 - 180.000; Jornada completa

Descripción de la vacante

Tallahassee Memorial HealthCare is seeking a Director of Ambulatory Quality & Regulatory Compliance to lead quality improvement and value-based care initiatives across our multi-specialty medical group. You will drive performance improvement, ensure regulatory compliance, and collaborate with physicians and leaders to optimize outcomes and financial performance.

The role focuses on HEDIS, STAR, MIPS metrics, care coordination, risk adjustment, and population health initiatives.

Formación

• Graduate of a school of Nursing.
• BSN degree preferred.
• Five years of experience in quality improvement/assurance.
• RN license in Florida or multistate compact.

Responsabilidades

• Lead quality improvement programs and performance initiatives.
• Develop, implement, and monitor quality management strategies.
• Analyze data to identify trends and improvement opportunities.
• Oversee value-based care programs (Medicare Advantage, MSSP, ACOs, etc.).
• Develop strategies to maximize quality incentives and contracts.
• Partner with physicians and clinical leaders to improve quality metrics and outcomes.
• Create provider performance scorecards and dashboards.
• Lead population health initiatives and risk adjustment activities.
• Ensure CMS, NCQA, Joint Commission, HIPAA compliance.

Conocimientos

Quality improvement

Performance analytics

Population health

Care coordination

Regulatory compliance

Educación

Graduate of a school of Nursing

Bachelor's Degree in Nursing (BSN)

Descripción del empleo

WHO WE ARE & WHAT WE DO

Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity of our community.TMH is the region's healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the region's only:

• Level II Trauma Center
• Primary Stroke Center
• Level III Neonatal Intensive Care
• Pediatric Intensive Care
• The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle.

Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices.

WHAT YOU’LL NEED TO APPLY

The Director of Ambulatory Quality & Regulatory Compliance is responsible for leading, developing, and implementing quality improvement and value-based care initiatives across a large multi-specialty medical group. This position drives performance improvement strategies that enhance clinical outcomes, patient experience, operational efficiency, and financial performance under value-based reimbursement models.

The Manager serves as a strategic partner to physicians, operational leaders, care teams, and executive leadership to ensure the organization meets quality benchmarks, regulatory requirements, population health goals, and payer performance targets. This role oversees quality programs, performance analytics, gap closure initiatives, risk adjustment activities, care coordination efforts, and value-based contracts.

Essential Duties and Responsibilities

• Lead quality improvement programs and performance initiatives that support organizational goals and patient outcome improvements.
• Develop, implement, and monitor quality management strategies using evidence-based improvement methodologies.
• Analyze quality, operational, financial, and population health data to identify trends, improvement opportunities, and organizational performance gaps.
• Oversee value-based care programs, including Medicare Advantage, MSSP, ACOs, commercial value-based contracts, bundled payment arrangements, and pay-for-performance initiatives.
• Develop strategies to maximize quality incentives, shared savings opportunities, and overall contract performance.
• Partner with physicians and clinical leaders to improve quality metrics, HEDIS measures, STAR Ratings, MIPS performance, patient satisfaction, and clinical outcomes.
• Create and maintain provider performance scorecards and dashboards to support accountability and performance improvement.
• Lead population health initiatives focused on chronic disease management, preventive care, care gap closure, annual wellness visits, transitions of care, and patient engagement.
• Identify high-risk patient populations and collaborate with care teams to implement targeted intervention strategies.
• Ensure compliance with CMS, NCQA, Joint Commission, HIPAA, and other regulatory and accreditation requirements.
• Coordinate quality reporting, regulatory submissions, and documentation related to quality performance programs.
• Collaborate with coding and clinical documentation teams to improve risk adjustment accuracy, RAF scores, and documentation integrity.
• Monitor utilization, readmissions, emergency department utilization, total cost of care, and quality outcomes to support organizational goals.
• Facilitate quality committees, performance review meetings, root cause analyses, and corrective action planning.
• Support care coordination programs designed to improve patient outcomes, reduce avoidable utilization, and enhance continuity of care.
• Develop annual quality work plans, performance objectives, and strategic initiatives aligned with organizational priorities.

Required Education:

• Graduate of a school of Nursing

Preferred Education:

• Bachelor's Degree in Nursing (BSN)

Required Experience:

• Five (5) years related experience demonstrating quality improvement/assurance skills and abilities.

Required Certification/License/Registry:

• Licensed as a registered nurse (RN) in accordance with Florida Statutes (FS), Title XXXII (Regulation of Professions and Occupations), Chapter 464 (Nursing), Part I (Nurse Practice Act) [includes multistate compact licensure]

Tallahassee Memorial HealthCare is an equal opportunity employer and drug-free workplace. All employment is contingent upon successful completion of a drug screen, background check, reference verification, health assessment, and credential/license verification.