Director, Clinical Quality, Training, Oversight and Innovation

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Clinical Quality, Training, Oversight and Innovation based in the United States.

This role offers the opportunity to lead clinical quality strategy and innovation initiatives that shape how healthcare data is collected, validated, and transformed into meaningful insights. The Director will oversee clinical training, quality assurance programs, and medical data abstraction processes across internal teams and external partners. You will serve as a key clinical authority, collaborating with product, operations, client services, and innovation teams to improve healthcare solutions. This position combines clinical expertise, operational leadership, compliance oversight, and strategic thinking within a technology-driven healthcare environment. The ideal candidate will bring deep experience in risk adjustment, HEDIS, medical coding, and clinical quality management. You will play a critical role in advancing healthcare data accuracy, regulatory compliance, and industry-leading practices.

Accountabilities:: The Director, Clinical Quality, Training, Oversight and Innovation will define and execute the organization’s clinical quality strategy while leading training, compliance, and oversight programs related to medical record data abstraction. This role requires a strategic clinical leader who can influence cross-functional teams, ensure operational excellence, and drive innovation in healthcare data processes.

Develop and execute the overall clinical quality strategy for medical record data abstraction across products, services, and operational teams.

Lead the design, implementation, and continuous improvement of clinical training programs for internal teams, partners, and international vendors.

Establish and oversee quality assurance processes to ensure accurate medical data abstraction, coding compliance, and adherence to regulatory requirements.

Serve as a subject matter expert in risk adjustment and HEDIS, providing clinical guidance to client services, business development, marketing, and internal stakeholders.

Represent clinical expertise externally through industry engagement, thought leadership, conferences, and professional presentations.

Partner with operational teams to monitor quality performance, identify improvement opportunities, and implement corrective action strategies.

Lead joint quality audit processes with clients, supporting audit readiness, compliance reviews, and client-specific quality initiatives.

Provide clinical guidance for the development and enhancement of tools, platforms, and systems supporting medical data abstraction.

Collaborate with innovation teams to evaluate emerging healthcare technologies, including AI and natural language processing solutions, while ensuring clinical and regulatory alignment.

Support the evaluation and onboarding of new data sources and electronic medical record partnerships to ensure data quality and compliance.

Establish clinical oversight processes for healthcare records received through interoperability and data exchange solutions.

Maintain strict adherence to healthcare privacy, confidentiality, HIPAA requirements, and organizational policies.

Requirements:

The ideal candidate will be an experienced clinical leader with a strong background in healthcare quality, compliance, medical coding, and training. This role requires a combination of clinical expertise, operational leadership, and the ability to drive innovation within complex healthcare environments.

Active Registered Nurse (RN) license required.

Bachelor’s degree in Arts/Sciences, Healthcare, Nursing, or a related field preferred.

12+ years of relevant healthcare experience, including at least 6 years in senior leadership or director-level management roles.

Minimum of 5 years of experience in healthcare quality and/or compliance.

Minimum of 5 years of experience with medical coding and healthcare data abstraction processes.

Minimum of 5 years of experience developing and delivering adult learning or professional training programs.

Strong knowledge of risk adjustment, HEDIS, clinical quality measurement, and healthcare regulatory requirements.

Experience leading quality oversight programs across internal teams, external partners, and vendor networks.

Strong understanding of healthcare technology, data collection tools, and clinical data workflows.

Ability to manage multiple priorities, meet deadlines, and operate effectively in a complex environment.

Excellent analytical skills with strong attention to detail and problem-solving abilities.

Advanced communication skills with the ability to influence stakeholders through clear written and verbal communication.

Proficiency with Microsoft Office and healthcare technology platforms.

Benefits:

Competitive salary range of approximately $132,000–$176,000 USD, depending on experience, skills, location, and business needs.

Potential eligibility for performance-based incentives.

Remote work flexibility within the United States.

Comprehensive benefits package designed to support health, financial goals, and work-life balance.

Health insurance, life insurance, and company-paid disability coverage.

401(k) retirement savings plan.

18+ days of paid time off and additional employee benefits.

Opportunity to lead impactful clinical quality initiatives within a healthcare technology environment.

Chance to influence the future of healthcare data accuracy, compliance, and innovation.

Collaborative environment with cross-functional exposure to clinical, product, operations, and technology teams.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1