Director, Quality Management

Job Description

Your Role

Reporting to the VP of Clinical Quality, the role of the Director is critical to the success of Blue Shield of California and the Clinical Quality department in realizing its goals and objectives. This individual will play a key role as part of the Quality team in delivering and collaborating on all aspects of quality outcomes. Establishes strategic plans, policies, and procedures at all levels and with all or critical operational departments to ensure quality programs will meet or exceed guidelines or requirements.

Specifically, the Director, Quality Management role will be accountable for ensuring that all Quality Management functions (Regulatory oversight, Committees, Policies and Procedures) are optimized resulting in audit readiness/regulatory compliance, ongoing NCQA Accreditation, and a high-quality program.

Responsibilities

Your Work

In this role, you will:

• Responsible for ensuring that Quality policies and procedures are in alignment with regulator expectations and in favor of delivering a high-quality program for the organization
• Responsible for organizing and facilitating Quality Committees and Subcommittees to drive a high-quality program for the organization while aligning with regulator requirements
• Ensure audit readiness for Quality Management
• Support NCQA Accreditation processes
  
  

Qualifications

Your Knowledge and Experience

• Minimum of 10 years prior relevant experience, including 6 years of management experience.
• Bachelor’s degree in Nursing, Public Health or other related field
• Requires in-depth knowledge of committee oversight, regulatory quality oversight, NCQA accreditation and standards.
• Prior experience driving and governing Quality Committees at a large health plan
• Comfortable with collaborating with executive audiences
  
  

About The Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield isa U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
  
  

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
• Member-facing and approved out-of-state roles remain remote.
• Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
  
  

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.