Director, Program Quality

Job Summary

Director, Program Quality to join our growing team. This position provides strategic and operational and regulatory leadership for the Imedecs quality program, including oversight of CMS Independent Dispute Resolution Entity (IDRE) and Independent Review Organization (IRO) programs, serving as the accountable quality authority for federally regulated dispute resolution and independent review functions under CMS. The Director role is responsible for end‑to‑end quality performance, regulatory compliance, audit outcomes and program integrity, with direct impact on contractual performance, financial risk, and client trust.

Operates with a high degree of autonomy and serves as a key liaison with CMS, clients, and accrediting bodies, ensuring alignment with evolving federal requirements and industry standards.

• Direct impact on federal program compliance and audit outcomes
• Influences client satisfaction, contract retention and revenue protection
• Responsible for quality performance across complex, high risk regulatory programs
• Operates within a high‑visibility externally scrutinized environment

• Owns quality strategy and execution for IDRE and IRO programs, ensuring alignment with CMS regulations, contractual obligations, and enterprise quality standards
• Accountable for program‑level quality outcomes, including accuracy, timeliness, audit performance and SLA adherence across high‑volume, nationally regulated operations
• Establishes and governs quality frameworks, KPIs and performance systems, including executive dashboards and reporting to senior leadership
• Leads regulatory compliance and audit strategy, including CMS audits, client audits and accreditation reviews (URAC) with direct accountability for outcomes
• Oversees quality assurance activities for IRO functions, including identification, escalation, and mitigation of compliance, operational, and reputational risks
• Drives continuous improvement initiatives impacting operational efficiency, cost and performance with measurable impact on program success and margin
• Provides executive level consultation to internal stakeholders on CMS regulatory requirements, IDRE processes, and quality performance implications
• Oversees vendor and partner quality performance, ensuring alignment with contractual and regulatory expectations
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

• Requires a bachelor's degree (master's degree preferred) from an accredited college or university
• 5+ years of management experience in a health‑related field; or an equivalent combination of education and relevant experience
• Demonstrated experience in vendor oversight, performance management, and cross‑functional leadership in a regulated environment

• Experience in healthcare quality, regulatory compliance, or review programs, with demonstrated exposure to CMS programs, IDRE, appeals, or dispute resolution environments preferred
• Knowledge of URAC, NCQA, IRO standards, and CMS regulatory requirements strongly preferred
• Experience with audit management, regulatory reporting, vendor oversight
• Ability to take initiative, provide leadership, maintain confidentiality, meet deadlines and work in a collaborative team environment
• Highly developed analytical skills with an ability to objectively evaluate data and perform statistical analysis
• Strong leadership and stakeholder management skills with the ability to operate effectively in a matrixed environment while maintaining program ownership

Benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

For non‑clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands‑on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

USD $ – $ / Yr.

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.