Director, Program Quality

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Director, Program Quality to join our growing team.

Job Summary:

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. This role 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

Responsibilities:

• 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

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Required Qualifications

• 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

Preferred Qualifications

• 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 oversite
• 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

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Experience in Lieu of Degree

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.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

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.