Director, Quality Compliance
What We Strive For
Strive Health is built for purpose — to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive’s model is driven by a high-touch care team that integrates with local providers and spans the entire care journey from chronic kidney disease through end-stage kidney disease, leveraging comparative and predictive data and analytics to identify at-risk patients. Strive Health’s interventions significantly reduce the rate of emergent dialysis crash, cut inpatient utilization and significantly improve patient outcomes and experience. Come join our journey as we create THE destination for top talent in the healthcare community and set a new standard for how kidney care should be done.
Why We’re Worth the Application
- We Strive for excellence and Strive has been recognized with six Best Place to Work awards, including Forbes America’s Best Startup Employers 2023 and 2022, Built In Colorado’s Best Places to Work 2022 and 2024, Comparably’s Best Places to Work in Denver 2022 and The Tech Tribune’s Best Startups in Denver 2022. Additionally, Strive’s CEO, Chris Riopelle, has been recognized as one of Denver Business Journal’s Most Admired CEOs.
- We derive innovation and ideas from through authentic diversity intentionally building a team that represents the populations we serve in partnership with our Employee Resource Groups:
- Strive Forward - LGBTQ
- Underrepresented Minorities
- Women and Allies
- We care and support our Strivers within and beyond work to feel fully charged and empowered through our generous wellbeing offerings including:
- Flexible time off
- Companywide wellbeing days
- Volunteer time off
- Leave packages including a sabbatical, parental leave and eight weeks paid for living donor
- Professional development
- A dedicated certified financial planner
- Headspace, Carrot Fertility and Gympass for all Strivers
- We like to have fun by celebrating our successes as a team through team building, company gatherings, trivia, wellbeing raffles, pajama days, a companywide book club and more.
- We value tenacity to help us overcome obstacles with grit and determination to deliver compassionate kidney care.
Director, Quality Compliance
The Director of Quality Compliance is accountable for defining strategic direction of the Quality Compliance program through development, implementation, monitoring, and evaluation of Strive Health’s accreditation, delegation, and Documentation Management programs The Director leads a team of associates which support all Quality Compliance activities. The Director utilizes expertise in NCQA accreditation, health plan delegation, and policy management to improve the Quality Program and support patient care. The Director, along with the Quality leadership team, works to improve patient outcomes, experience, and safety through Quality improvement initiatives. The Director leads regular mock audits and partners closely with legal and regulatory affairs to ensure that strive maintains continuous readiness for audits and accreditation requirements. The Director reports to the VP, Quality and is able to ensure day-to-day processes are conducted in accordance with NCQA Standards and other internal and regulatory standards.
- Provides strategic and day-to-day guidance, leadership, and development to the Quality Compliance team to ensure all components of accreditation, delegation, and documentation management meet expectations of internal and external partners.
- Creates strategies to develop a continuous readiness program for NCQA accreditations and delegated activities.
- Partners with the markets and clinical teams across all verticals of business to ensure policy and process is maintained in accordance with established standards. Effectively communicates gaps and recommendations for improvements.
- Develops and maintains reporting and analyses for clinical program effectiveness, in partnership with the Director of Quality Improvement and the Sr. Manager of Patient Experience.
- Acts as advisor to market and business on appropriate documentation and qualitative and quantitative analyses for required improvement opportunities and assuring business owners are acting on their opportunities for improvement.
- Perform a variety of complex work in planning, coordinating, amending and managing continuous readiness activities, utilizing a strong understanding of the business processes related to corporate/market operations and accreditation standards.
- Holds deep knowledge and experience as the SME for NCQA Health Plan requirements and standards, and stand-alone CM and PHP accreditations.
- Working knowledge of Credentialing NCQA requirements for delegation.
- Expert with program management for mock audit NCQA readiness
- Expert in the NCQA submission process
- Provides guidance and oversight of the delegated services and reporting.
- Works with the contracting team to ensure all pre-delegation requirements and delegation agreements align with Strive services. Is the point of contact for new implementations.
- Supports the Sr. Associate, Delegation in the day-to-day delegation requirements from payor partners.
- Serves as the Senior leader point of contact for delegation escalation issues
- Demonstrates expertise in policy requirements and management.
- Educates and recommends policy and process changes to meet accreditation requirements.
- Chairs the Policy Review Committee
- Leads, with support from the Associate, Accreditation and Delegation, the Policy Review Committee
- Bachelor's Degree in related fields or an equivalent combination of education and experience.
- 8+ years' related experience (quality, compliance, etc.)
- 6+ years’ experience in Health Plan, CM, and/or DM NCQA and/or other Quality accreditation work. Actively managed a minimum of three full cycles of an accreditation submission.
- 6+ years’ experience with client management
- 5+ years’ experience with delegation oversight, preferably in a managed care setting
- Bachelor’s Degree in Nursing or other health-related field required; Graduate degree in related field or equivalent combination of education and experience preferred
- Complex Case Management auditing
- Certified Case Manager
- Strong clinical assessment and critical thinking skills
- Excellent verbal and written communication skills
- Ability to work in a team environment.
- Flexibility and strong organizational skills needed.
- Proficiency in Microsoft Office, Adobe Acrobat and internet/web navigation.
- Care Management Certification
- Will substitute 5 or more years of clinical experience along with an associate degree and RN licensure in place of the bachelor’s degree and RN licensure.
- NCQA Case Management and Population Health accreditation standards and process experience
- Knowledge of the organization of medical records, medical terminology, and disease process
- Remote experience preferred.
Annual Salary Range: $130,000.00-$163,000.00
Strive Health offers competitive compensation and benefits, including Health insurance, Dental insurance, Vision insurance, 401k Retirement Plan with Employer Match, Life and Accidental Death & Dismemberment insurance, Disability insurance, Health Savings Account, Flexible Spending Account, paid company holidays, in addition to Vacation Time Off. An annual performance bonus, determined by company and individual performance, is available for many roles as aligned to Strive Health guidelines.
Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Please apply even if you feel you do not meet all qualifications. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to email@example.com