Who We Are:

FlyteHealth exists to help individuals living with obesity pursue healthier lives through chronic condition support and pharmacotherapy virtually via video conferencing and an engaging smartphone app. We leverage an in-house nationwide clinical care team including physicians, nurse practitioners, registered dietitians, and care navigators. We also partner with hospital systems, payers, and PBMs to expand their ability to reach more patients and provide broader obesity care support.

Job Summary:

We are seeking an experienced and driven Vice President of Clinical Quality & Practice Operations to lead organization-wide healthcare quality and clinical operations support across diverse employer and payer clients with varying patient needs. This leadership role encompasses oversight of credentialing,quality, data monitoring and performance, medical records management, chart audits and performance and the clinical support team—including Medical Assistants (MAs), Licensed Practical Nurses (LPNs), and Registered Nurses (RNs)—who provide operational and clinical support to the clinical network. The ideal candidate brings expertise in HIPAA, NCQA, HEDIS, and audit management, with a strong clinical foundation and proven leadership in healthcare quality, telehealth, and performance monitoring.

Leadership & Oversight

• Lead and manage Quality Operations, Credentialing, and Clinical Support Teams ensuring alignment with strategic and regulatory priorities.
• Supervise and support the clinical support staff (MAs, LPNs, RNs) who serve as operational and clinical extensions of the provider network, ensuring effective workflows, training, and staff development.
• Manage clinical escalations, appeals, and crisis response processes for services including patient side effects and prescribing,
• Provide leadership in managing clinical escalations, appeals, member complaints, and crisis response operations across therapy, virtual prescribing, and coaching lines.
• Oversee and enhance internal and external audit readiness (FDR, NCQA, CMS), managing client audits and corrective action plans as needed.

Risk Management

• Develop and maintain policies and procedures to ensure compliance with HIPAA, HEDIS, NCQA, CMS, and other relevant standards.
• Conduct gap analyses to identify operational and regulatory risks, implementing mitigation plans and continuous process improvement.Act as the primary liaison with legal counsel to manage investigations, external inquiries, and special compliance projects.

Quality Assurance

• Lead clinical quality assurance initiatives including the design and execution of provider audit methodologies and performance reviews.
• Conduct training and documentation reviews to ensure accuracy, regulatory alignment, and improved patient outcomes.
• Collaborate cross-functionally to integrate compliance strategies with organizational goals and initiatives.

Audit & Vendor Oversight

• Direct sub-delegation and third-party vendor audits to ensure performance meets contractual and regulatory standards.
• Evaluate and manage HEDIS projects and reporting for Employer Clients, Medicaid and Medicare lines of business.
• Prepare and deliver quality and compliance dashboards to executive leadership and client partners.

Clinical & Administrative Operations

• Support clinical documentation initiatives, education, and training to maintain high standards of care and service.
• Collaborate with clinical, operational, and IT teams to support EMR optimization, clinical workflows, and care delivery innovations.
• Lead cross-functional initiatives to align virtual cardiometabolic services with evolving regulatory landscapes and payer requirements.

Qualifications:

• Minimum of 10 years of progressive experience in virtual healthcare operations, compliance, or quality leadership roles.Strong knowledge of HIPAA, HEDIS, NCQA, CMS, and federal/state healthcare regulations.
• Nurse/APRN/LPN experience required
• Experience in telehealth operations, including clinical documentation, regulatory compliance, and quality oversight.
• Proven ability to lead teams and projects in remote, matrixed environments.
• Demonstrated success in managing audits, quality programs, and risk mitigation initiatives.
• Experience with Athena, and advanced Microsoft/Google productivity tools.

FlyteHealth Benefits:

• *Eligibility for Essential benefits: Full-time employees regularly working 30+ hours per week
• Comprehensive health, dental and vision insurance
• Equity Shares
• 401(k)
• Parental leave

FlyteHealth Perks:

• Remote-first Company
• Internet Stipend for remote working
• Paid Company Holidays