Clinical Quality Governance & Regulatory

Senior Director, Clinical Quality Governance & Regulatory

Location: Atlanta, GA (Onsite)
Employment Type: Permanent | Full-Time
Industry: Healthcare
Salary:$194,700-$251,900
 

About the Organization

A leading integrated healthcare organization is seeking a Senior Director, Clinical Quality Governance & Regulatory to provide executive leadership for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance. The organization is committed to delivering high-quality, patient-centered care through evidence-based practices, continuous quality improvement, and strong clinical governance across its healthcare operations.

Job Summary

The Senior Director, Clinical Quality Governance & Regulatory will provide strategic oversight for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance. This senior leader will serve as a key partner to governing boards and executive leadership, ensuring effective governance, quality performance, and accountability across health plan and care delivery operations.

This position is responsible for overseeing clinical quality and patient safety management programs, including budget oversight, annual program evaluations, preparation of internal and external reports, consultation services, education initiatives, outcome measurement, and quality improvement strategies related to clinical quality, accreditation, regulatory and licensing compliance, risk management, and infection prevention and control.

The role also establishes standards and strategies for evaluating, designing, developing, and implementing evidence-based guidelines and quality programs to reduce variation in clinical practice, optimize patient outcomes, and ensure regulatory compliance. Responsibilities include leading the collection, analysis, reporting, and presentation of clinical quality data to identify trends, outliers, and opportunities for improvement, while developing education strategies that address regulatory changes and organizational quality goals.

Additionally, the Senior Director serves as a strategic leader for monitoring, reporting, and mitigating risks that could result in organizational liability, supports continuous regulatory survey readiness, and develops collaborative relationships with government agencies, accreditation bodies, and other regulatory organizations.

Essential Responsibilities

Executive Leadership

• Build organizational capability by developing high-potential leaders and succession plans.
• Foster collaborative relationships across departments and external stakeholders.
• Establish frameworks for performance feedback, coaching, and continuous improvement.
• Lead recruitment, talent development, succession planning, and workforce engagement initiatives.
• Stay current on healthcare quality trends, regulatory requirements, and industry best practices.
• Promote collaboration, accountability, and continuous learning throughout the organization.
• Align departmental resources with organizational priorities and strategic objectives.
• Provide leadership and guidance for complex organizational decisions impacting quality and patient safety.

Operational Leadership

• Oversee multiple departments responsible for clinical quality, patient safety, and regulatory compliance.
• Translate organizational strategy into actionable operational plans.
• Ensure services meet organizational goals and stakeholder expectations.
• Collaborate with cross-functional leaders to implement strategic initiatives.
• Establish goals, monitor performance, allocate resources, and resolve escalated operational issues.
• Serve as a trusted advisor to executive leadership on quality improvement and compliance strategies.
• Remove operational barriers and implement contingency plans to achieve business objectives.

Clinical Quality Data & Reporting

• Direct data collection, statistical analysis, and reporting supporting quality improvement initiatives.
• Oversee development and integration of clinical quality reporting systems.
• Develop and maintain statistical reports that support evidence-based quality improvement.
• Present quality metrics and performance outcomes to executive leadership, governing boards, and external agencies.
• Provide expert consultation on clinical data collection, analysis, reporting methodologies, and organizational performance measurement.

Quality Improvement & Risk Management

• Lead enterprise-wide quality improvement and risk management initiatives.
• Implement corrective action plans resulting from utilization reviews, clinical audits, claim denials, member satisfaction surveys, and regulatory findings.
• Ensure improvement initiatives comply with internal policies and external regulatory standards.
• Utilize Root Cause Analysis (RCA), Failure Mode and Effects Analysis (FMEA), and other quality methodologies to identify system improvements.
• Establish policies, procedures, and mitigation strategies that reduce future organizational risk.
• Define organizational standards for identifying, escalating, and resolving high-risk quality concerns.

Performance Measurement

• Develop enterprise performance metrics supporting organizational quality goals.
• Collaborate with executive leadership to establish measurable quality standards.
• Ensure quality metrics align with multidisciplinary clinical standards and strategic priorities.
• Integrate performance measurement into organizational workflows and improvement initiatives.
• Provide expertise in project governance, quality dashboards, performance reporting, and organizational scorecards.

Strategic Quality Improvement

• Establish the long-term vision for quality improvement initiatives across the organization.
• Promote the adoption of technology, analytics, and evidence-based improvement methodologies.
• Serve as an executive advisor on Lean, Six Sigma, quality improvement tools, and data-driven decision-making.
• Develop long-term implementation plans, milestones, documentation standards, and governance structures.
• Partner with stakeholders to ensure consistent application of quality methodologies and continuous improvement practices.

Regulatory Compliance & Clinical Governance

• Serve as the executive subject matter expert on healthcare quality regulations and compliance.
• Interpret evolving healthcare legislation, accreditation standards, and regulatory requirements.
• Advise executive leadership regarding long-term compliance strategies and organizational impacts.
• Collaborate with regulatory agencies, accreditation organizations, and healthcare partners.
• Lead educational initiatives that promote regulatory awareness and compliance across the organization.
• Identify barriers to compliance and recommend strategic policy improvements.

Performance Review & Education

• Oversee enterprise quality performance review processes.
• Establish organizational standards for utilization reviews and quality assessments.
• Develop corrective action standards and performance improvement expectations.
• Present quality performance results to executive leadership and external regulatory agencies.
• Define training standards and educational programs supporting quality improvement initiatives.

Minimum Qualifications

• Minimum four (4) years of experience managing operational or project budgets.
• Minimum six (6) years of leadership experience managing direct reports.
• Minimum two (2) years of experience using databases, spreadsheets, or Continuous Quality Improvement (CQI) tools.
• Minimum eight (8) years of experience in a clinical setting, healthcare administration, or related healthcare field.

Education Requirements

• Master's degree in Business Administration, Healthcare Administration, Nursing, Public Health, or a related field with a minimum of eight (8) years of healthcare quality assurance/improvement experience; OR
• Bachelor's degree in a related field with a minimum of ten (10) years of healthcare quality assurance/improvement experience; OR
• Minimum thirteen (13) years of directly related healthcare quality assurance/improvement experience.

Required Certifications & Licensure

• Active Registered Professional Nurse (RN) license in the State of Georgia.
• One of the following certifications must be obtained within 24 months of hire:
  • Certified Professional in Patient Safety (CPPS)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Certified Professional in Healthcare Risk Management (CPHRM)