Head of Quality

Antidote Health Group; New York (NY); On-site; USD 225,000 - 270,000; Full time

Benefits offered by this job

Equity

401(k)

Paid vacation

Company holidays

Job summary

Antidote Health in New York seeks Head of Quality to lead enterprise quality vision and performance across state and federal programs. This executive role designs and governs a comprehensive quality program driving clinical outcomes, member experience, regulatory results, and accreditation success.

You will partner with Product, Technology, Analytics, Clinical Operations, Network, Pharmacy, and Member Services to embed quality across workflows and decisions, with primary accountability for

Qualifications

• Bachelor’s degree required in Nursing, Public Health, Health Administration, or related field.
• 10+ years of progressive experience in health plan quality, including HMO/QHP programs.
• 5+ years in senior leadership (Director level or above).
• Deep expertise in HEDIS, CAHPS, QHP Enrollee Survey, QRS, QIS, and NCQA Accreditation.
• Proven ability to translate regulatory requirements into operational, technical, and analytical solutions.

Responsibilities

• Define and execute an enterprise quality strategy, governance, and KPI framework.
• Lead QHP quality performance and member experience initiatives across programs.
• Translate data into actionable quality initiatives and enable real-time performance visibility.
• Oversee provider quality strategy, scorecards, and performance-improvement programs.
• Lead readiness for NCQA accreditation and regulatory compliance across the enterprise.
• Oversee quality of care processes, case reviews, escalation, and corrective actions.
• Identify and address health equity gaps; align population health strategies with quality goals.
• Collaborate with cross-functional teams to ensure quality is embedded across workflows.

Education

Bachelor’s degree in Nursing

Job description

Antidote Health is a tech- driven health insurance company on a mission to make healthcare easy, accessible, and more affordable. We’re rethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences, we’re building a simpler, more connected way for people to get care.

Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help people actually use their benefits.

We offer Affordable Care Act (ACA) health plans in Arizona and Ohio, and we’re growing quickly. We’re building a company focused on solving real problems—with real impact on people’s lives.

Position Overview

Antidote Health Plan is seeking a strategic, executive-level Head of Quality to lead the enterprise quality vision, strategy, and performance across all state and federal programs. This role is accountable for designing, governing, and continuously improving a comprehensive quality program that drives superior clinical outcomes, member experience, regulatory performance, and accreditation results.

The Head of Quality serves as the organization’s enterprise authority on HEDIS®, CAHPS®, QHP Enrollee Survey, Secret Shopper Survey (SSS), Quality Rating System (QRS), Quality Improvement Strategy (QIS), and NCQA Health Plan Accreditation. This leader ensures that quality requirements are translated into scalable data, operational, and technology capabilities while maintaining clear separation between strategic oversight and delegated operational execution.

The role is highly cross-functional, partnering with Product, Technology, Analytics, Clinical Operations, Network, Pharmacy, and Member Services to ensure quality is embedded across all workflows and decision-making.

This position is intentionally designed as a strategic, oversight-oriented leadership role, with primary accountability for:

• Enterprise quality strategy, performance management, and governance
• Data enablement and real-time performance visibility through Technology and Analytics
• Regulatory readiness and accreditation success
• Cross-functional alignment and execution accountability

Key Responsibilities

1. Enterprise Quality Strategy & Governance

• Define and execute a multi-year enterprise quality strategy aligned with regulatory requirements, accreditation standards, and organizational goals and KPIs
• Lead the annual Quality Improvement Program (QIP), including program description, work plan, performance monitoring, and evaluation
• Establish governance structures, KPIs, and reporting frameworks to track performance and outcomes
• Present quality performance, risks, and improvement initiatives to executive leadership and governing bodies
• Promote a culture of continuous quality improvement across the enterprise

2. QHP Quality Performance & Member Experience

• Lead enterprise strategy for QRS, QHP Enrollee Survey, CAHPS®, and Secret Shopper Survey (SSS)
• Oversee Quality Improvement Strategy (QIS) design, execution, and evaluation
• Translate survey and performance data into actionable initiatives to improve access, service, and care coordination
• Ensure readiness for all QHP quality reporting and performance cycles
• Establish enterprise HEDIS® strategy, timelines, and performance targets
• Provide executive oversight of HEDIS® execution, including data sources, medical record review, validation, and submission
• Analyze performance trends and lead cross-functional interventions to close gaps in care
• Ensure HEDIS requirements are translated into scalable workflows, reporting logic, and system capabilities

4. Data, Technology & Performance Enablement

• Serve as the business lead translating quality requirements into data, reporting, and technology solutions
• Partner with Technology and Analytics to build:
• Quality dashboards and scorecards
• Provider performance reporting tools
• Ensure enterprise data quality, validation controls, and submission accuracy

5. Provider Quality & Network Performance

• Lead provider quality strategy across HEDIS®, CAHPS®, and QRS measures
• Develop provider scorecards, engagement strategies, and performance improvement initiatives
• Support value-based and incentive-based quality programs

6. NCQA Accreditation & Regulatory Readiness

• Lead readiness, execution, and maintenance of NCQA Health Plan Accreditation
• Ensure policies, procedures, and operations align with accreditation and regulatory requirements
• Maintain subject matter expertise in federal and state quality regulations for QHPs
• Serve as executive liaison for regulatory and accreditation bodies
• Oversee all vendors and delegated entities supporting quality functions
• Establish performance expectations, SLAs, and accountability frameworks
• Monitor delegated functions (e.g., UM, Pharmacy, Credentialing) for compliance and performance
• Ensure consistent implementation of quality workflows across the organization

8. Quality of Care & Enterprise Monitoring

• Oversee Quality of Care processes, including case review, escalation, and corrective action tracking
• Monitor grievances, appeals, and complaints to identify systemic improvement opportunities
• Partner with clinical and operational leaders to ensure resolution and sustained improvement

9. Health Equity & Population Health

• Identify disparities in care and member experience using quality and operational data
• Lead initiatives to improve equitable access, outcomes, and experience
• Align population health strategies with enterprise quality goals

Qualifications

Required

• Bachelor’s degree in Nursing, Public Health, Health Administration, or related field
• 10+ years of progressive experience in health plan quality, including HMO/QHP programs
• 5+ years in senior leadership (Director level or above)
• Deep expertise in HEDIS®, CAHPS®, QHP Enrollee Survey, QRS, QIS, and NCQA Accreditation
• Proven ability to translate regulatory requirements into operational, technical, and analytical solutions

Preferred

• RN and/or CPHQ certification
• Experience in growth-stage environments
• Experience with provider performance programs and value-based models
• Strategic Vision: Ability to define and execute long-term quality strategy
• Influence & Collaboration: Drive alignment across executive and operational stakeholders
• Executive Presence: Communicate complex concepts clearly to diverse audiences
• Execution & Accountability: Deliver measurable performance improvement in a fast-paced environment
• Technical Translation: Bridge quality requirements with systems, workflows, and analytics

Compensation and Benefits

• Base salary range: $225,000-270,000 (commensurate with experience and location)
• Eligibility for equity
• 401(k)
• Paid vacation and sick time and company holidays

Company Standards and Expectations

• Employment is at-will, meaning either the employee or the company may terminate employment at any time, with or without cause, in accordance with applicable law
• Employees are expected to adhere to all company policies, including confidentiality, data protection, and code of conduct
• Responsibilities may evolve based on business needs, and flexibility is expected as the company scales
• Compliance with all applicable federal, state, and local laws and regulations is required

Equal Opportunity Statement

Antidote Health is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law.