Director of Clinical Operations, Quality & Performance Programs

About this role

Job Summary  

At Fuze Health, we put patients first and tirelessly address the most pressing needs in healthcare. We empower millions to digitally connect with care providers, essential health resources and needed treatments – and enable care providers, employers, health plans and life sciences companies to meaningfully enhance quality, outcomes and value. We are dedicated to helping our partners evolve and modernize to meet emerging patient and marketplace needs.

Fuze Health’s foundation is built upon the strategic combination of several proven, technology-powered innovators in the digital health, diagnostics, and pharmacy sectors. Our growing portfolio brings together the capabilities of industry leaders including LetsGetChecked, Truepill, and Alto Pharmacy, to create a distinctive, unified force in healthcare. Together, we have the shared vision, advanced capabilities and talented teams to deliver next-generation solutions that patients and healthcare partners need today and into the future.

Job Description   The Director, Quality & Performance Programs drives strategic and operational excellence across healthcare quality programs, clinical data systems, contact center operations, and external client partnerships. Acting as the central leader for quality program performance, this role translates complex clinical and quality requirements into scalable strategies, workflows, and operating models that improve outcomes, close gaps in care, and deliver measurable value for clients. You will lead and develop high-performing teams while overseeing the execution and continuous optimization of complex, high-volume programs, ensuring operational readiness to navigate volume spikes, evolving program requirements, and time-sensitive performance goals. Partnering dynamically across clinical, operations, data, technology, and client-facing teams, you will leverage performance analytics, quality metrics, and actionable insights to drive accountability, strengthen client relationships, identify opportunities for improvement, and build scalable programs that consistently deliver exceptional quality and performance outcomes.

Key Responsibilities: • End-to-End Measure Closures: Drive the strategy and execution for closing clinical quality gaps (STARS/HEDIS), ensuring maximum accuracy, compliance, and throughput. • Capacity & Staffing Projections: Develop complex staffing models based on historical and real-time throughput data to ensure optimal staffing levels during peak seasons. • Agile Scaling: Rapidly scale and ramp up team size, technology, and workflows to successfully manage sudden volume surges and intake spikes. • Cadence Leadership: Facilitate critical operational reviews, including Daily Syncs, Weekly Business Reviews (WBRs), and Monthly Business Reviews (MBRs), to keep stakeholders aligned. • Client-Facing Representation: Act as the primary operational point of contact for clients, delivering high-impact presentations and managing expectations with transparency. • Quality & Compliance Audits: Lead preparation efforts for rigorous external and client-led audits. • Call Listening & Calibration: Conduct and facilitate joint client call-listening sessions to monitor agent quality, align on compliance guidelines, and refine training protocols. • Systems Oversight: Leverage a deep understanding of telephony setups (IVR, dialer strategies) and Electronic Medical Record (EMR) systems to streamline workflows and improve data retrieval speeds. • Vendor Partners: Manage third-party contractors and vendors, holding them accountable to strict service level agreements (SLAs) and budget parameters.

Required Experience & Qualifications: Minimum Qualifications: • 5+ years of direct experience in healthcare quality operations, with a strong focus on Medicare STARS program metrics, HEDIS reporting, or risk adjustment.  • STARS/HEDIS Subject Matter Expert: Strong, foundational knowledge of NCQA guidelines, HEDIS specifications, and Medicare Star Ratings.  • Data & Analytics (Looker): Direct experience using Looker (or similar business intelligence tools) to track key performance indicators (KPIs), monitor throughput, and make data-driven staffing decisions.  • Systems Fluency: Practical, hands-on experience navigating major EMR platforms and cloud-based contact center telephony platforms. • High proficiency in G Suite / Google Workspace (Docs, Sheets, Slides, Drive) to create client presentations, manage operational trackers, and facilitate meetings.   • WFM & Staffing Calculations: Demonstrated ability to project staffing needs and scale personnel dynamically based on data throughput during peak HEDIS seasons. 

Preferred Qualifications: • Client Management: 2+ years of experience in a client-facing role, managing corporate healthcare clients, payers, or enterprise accounts.  • Proven Gap Closure Performance: Deep experience managing end-to-end measure closures and executing targeted interventions to boost performance.  • Strategic STARS Planning: Experience assisting with or designing strategic initiatives to achieve and maintain the ratings. • Executive Presentation: Exceptional communication skills with the ability to translate complex operational data into clear, actionable updates for executive leadership and clients.  • Vendor & Scaling Experience: Proven track record of managing third-party vendor contracts and rapidly scaling temporary contractor workforces during seasonal ramp-up periods. 

Additional Information   Physical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. The role also requires the ability to effectively communicate through verbal interactions, discern auditory info

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