Sr. Director, Clinical Quality Governance & Regulatory

Location: Atlanta, GA (100% Onsite)

Industry: Healthcare / Health Plan & Care Delivery Operations

Position Type: Full-Time, New Role

Base Compensation: $194,700 – $251,900 / year (Midpoint ~$229,000; compensation flexibility available for exceptional candidates)

Incentive: 20% Annual Target Bonus

Relocation: Case-by-case eligibility

Sponsorship: No visa sponsorship provided

Executive Summary

The Senior Director, Clinical Quality Governance & Regulatory provides high-level strategic oversight for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance across both health plan and care delivery operations.

Serving as a trusted expert and key partner to local and national executive boards, this leader establishes overarching governance frameworks, drives evidence-based practice changes, and ensures organizational accountability. This role translates regulatory and accreditation requirements into actionable, long-term continuous improvement strategies that minimize liability, elevate clinical outcomes, and uphold operational excellence.

Key Responsibilities

Strategic Leadership, Governance & Team Empowerment

• Executive Advisory: Serve as a subject matter expert to executive leadership and boards, providing strategic guidance on clinical quality, patient safety, and liability mitigation.
• Team Development: Build organizational capacity, mentor high-potential staff, oversee talent selection, and drive continuous learning and cross-functional engagement.
• Operational Alignment: Translate macro-level business strategies into unit goals, managing budgets, resource allocation, and operational risk across multiple departments.

Quality Improvement, Data Analytics & Risk Management

• Data & Analytics Oversight: Direct data collection, statistical analyses, and reporting workflows (e.g., Lean/Six Sigma) to evaluate quality metrics, identify clinical trends, and present findings to executive leadership.
• Risk & Patient Safety: Oversee root cause analyses (RCA), failure mode and effects analyses (FMEA), near-miss responses, and medical center liability monitoring to establish corrective policies and reduce risk.
• Metric Integration: Consult with cross-functional executive stakeholders to establish practical, reachable, and standardized performance metrics integrated directly into clinical workflows.

Regulatory Compliance & Accreditation

• Continuous Survey Readiness: Lead ongoing readiness initiatives for state, federal, and continuous survey accreditation bodies (e.g., The Joint Commission, NCQA, CMS).
• Agency Relations: Cultivate strong collaborative partnerships with government and regulatory agencies, staying ahead of legislative changes impacting health plan and delivery operations.
• Credentialing & Peer Review: Oversee processes and criteria for clinical performance reviews, credentialing, and peer reviews at the organizational level.

Candidate Qualifications

Must-Have Requirements

• Leadership Experience: Direct executive/quality leadership experience within a large healthcare system or hospital setting AND health plan experience.
• Clinical Background: Hands-on clinical experience alongside administrative leadership.
• Core Subject Expertise: Deep expertise in Credentialing, Peer Review, Patient Safety, Risk Management, and Quality Governance.
• Regulatory & Quality Programs: Proven track record with:
  • CMS 5-Star ratings
  • HEDIS metrics
  • The Joint Commission survey leadership
  • NCQA outcomes

Minimum Education & Work Experience

• Experience:

• Minimum 8 years of experience in a clinical setting, healthcare administration, or related field.
• Minimum 6 years in a leadership role managing direct reports.
• Minimum 4 years managing operational or project budgets.
• Minimum 2 years working with databases, spreadsheets, or Continuous Quality Improvement (CQI) tools.
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• Education & Experience Combinations:
  • Master’s Degree (MBA, HCA, MSN, MPH, or related) + 8+ years of healthcare quality assurance/improvement experience OR
  • Bachelor’s Degree (BA/BS in related field) + 10+ years of healthcare quality assurance/improvement experience OR
  • 13+ years of progressive experience in healthcare quality assurance/improvement.

Licenses & Certifications

• Active RN License: Current Registered Professional Nurse License in the State of Georgia (or clear path to obtain prior to hire).
• Certifications: Must possess (or obtain within 24 months of hire) at least one of the following:
  • Certified Professional in Patient Safety (CPPS)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Certified Professional in Healthcare Risk Management (CPHRM)