Director of Order Management & Quality Compliance

Job Details

Description

This role serves as the front-end control owner for Customer Operations, leading the teams, workflows, and quality disciplines that determine whether an order is clean, compliant, and ready to move forward. The Director partners closely with Sales, fulfillment, revenue cycle, and clinical stakeholders to define intake standards, enforce handoff contracts, and build a disciplined operating model that protects patients, supports payer compliance, and improves execution reliability.

Competencies & Skills Needed

• Adaptability & Innovation – Demonstrates flexibility and adaptability in response to changing priorities, effectively guiding the team through Embraces new ideas and approaches, encourages innovation, and fosters continuous improvement. Leads the team in implementing creative solutions and innovative strategies.
• Leading Change: Drives the necessary organizational and cultural changes to achieve Altivera Medical’s strategic priorities by actively initiating, supporting, and implementing transformations while aligning stakeholders, reducing resistance, and fostering adaptability.
• Driving Execution: Translates Altivera Medical’s priorities into operational reality by creating a culture of accountability, managing resources effectively, addressing challenges, and aligning individual actions with organizational objectives to achieve results.
• Coaching & Developing Others: Provides constructive feedback on development opportunities to empower team members in their current or future roles. Encourages and facilitates skill enhancement, career advancement, and goal achievement through continuous one-on-one dialogue.
• Reliability - Demonstrates consistent follow-through on commitments while upholding high standards, even under pressure. Takes ownership of results, decisions, and actions, which is vital for organizational stability.
• Strategic Influence - Utilizes influence strategies to secure commitment and persuade stakeholders to advance shared interests and priorities. Demonstrates the ability to guide, inspire, and align stakeholders with organizational goals through insight, credibility, and vision.
  
  

Essential Job Duties & Responsibilities

Order Intake & Validation

• Own the intake and order-validation operating model from order receipt until an order is deemed clean or explicitly exceptioned.
• Establish completeness standards, intake rules, and hard-stop versus soft-stop criteria to ensure orders meet clinical, payer, and operational requirements before progressing downstream.
• Eliminate unnecessary intake handoffs and redesign front-end workflows to improve speed, accountability, and control.
• Lead the interpretation and operational application of payer coverage rules, authorization requirements, documentation standards, and medical necessity expectations by payer, product, and state, with a defined escalation path for gray-area cases.
• Define and audit the standards for required documentation, including physician orders, medical necessity support, payer-required forms, and other clinical or regulatory elements needed for compliant progression.
• Oversee front-end control desk activities, including work-in-progress visibility, aging management, stall-reason tracking, and daily prioritization of constrained work.
• Build clinical and regulatory quality mechanisms, including certification or gating for high-risk work, QA sampling, error taxonomy, and corrective action processes for recurring defects.
• Define and enforce the sales-to-operations contract by clarifying what must be delivered upstream, rejecting non-compliant orders consistently, and preventing downstream teams from absorbing avoidable defects.
• Maintain control documentation, operational reporting, and audit-ready records that support visibility into intake performance, compliance adherence, and root-cause trends.
  
  

Medical Necessity, Payer Policy & Clinical Compliance

• Serve as the organization’s point owner for front-end compliance decisions related to clinical completeness, payer rules, and documentation sufficiency before order release.
• Monitor payer-policy changes and translate them into operational updates, training, checklists, and workflow controls that reduce preventable errors.
• Establish structured exception-management and escalation processes for complex or ambiguous cases, ensuring decisions are timely, documented, and consistently applied.
• Ensure readiness for audits and reviews by maintaining defensible documentation standards, traceability, and corrective action disciplines across front-end operations.
• Track and report key performance indicators (KPIs) such as clean orders at intake, intake-to-clearance cycle time, medical necessity error rate, stall aging by reason, and sales-originated defect rate.
• Partner with Sales, Operations, Revenue Integrity, and executive leadership to strengthen upstream accountability, improve decision quality, and protect downstream flow.
  
  

Leadership & Team Oversight

• Lead, coach, and develop managers and subject matter experts responsible for intake quality, documentation review, compliance support, and front-end workflow execution.
• Set operating cadence, review mechanisms, and performance expectations that create visibility, accountability, and disciplined execution across the team.
• Assess capability gaps and build the staffing, training, and role clarity needed to support a stronger control environment.
• Drive cross-functional process improvement initiatives focused on reducing defects, improving handoffs, and stabilizing operational performance.
• Serve as a firm, evidence-based decision-maker who can uphold standards and navigate difficult tradeoffs in a regulated operating environment.
  
  

Communication & Cross-Functional Partnership

• Communicate clearly with internal leaders and operational partners regarding intake standards, exception decisions, compliance risks, workflow priorities, and performance trends.
• Partner with Sales, fulfillment, revenue cycle, and clinical stakeholders to resolve escalations, clarify ownership, and strengthen upstream and downstream handoff quality.
• Provide direction, coaching, and structured feedback to team members and managers while reinforcing documentation discipline, policy adherence, and sound operational judgment.
• Escalate unresolved compliance, clinical, or operational risks appropriately and influence decisions through data, evidence, and clear rationale.
  
  

Additional Leadership Expectations

• Maintain a strong culture of compliance, accountability, responsiveness, and operational discipline.
• Use data and process observation to identify breakdowns, prioritize interventions, and improve front-end order quality performance.
• Support organizational change efforts tied to stabilization, workflow redesign, and capability building.
• Ensure teams follow company policies, regulatory requirements, payer standards, and departmental procedures.
• Perform other leadership responsibilities and special projects as assigned.
  
  

Minimum Qualifications

• Strong working knowledge of medical necessity requirements, payer policy interpretation, documentation standards, and regulated healthcare operations.
• Demonstrated leadership experience in order quality, intake, clinical compliance, revenue cycle operations, utilization management, or a closely related healthcare environment.
• Proven ability to build controls, enforce standards, manage escalations, and improve performance in high-risk operational workflows.
• Strong analytical and problem-solving skills with the ability to use data to drive decisions, identify root causes, and implement corrective actions.
• Excellent written and verbal communication skills, including the ability to influence cross-functional stakeholders and hold firm boundaries when needed.
• Experience leading managers, developing talent, and creating accountability in complex operational settings.
• High attention to detail, sound judgment, and the ability to operate effectively in a fast-paced, highly regulated environment.
• Proficiency with Microsoft Office and relevant healthcare, documentation, or workflow systems.
  
  

Preferred Profile

The ideal candidates will bring the following attributes:

• Policy-literate and comfortable making defensible compliance decisions, not just operational judgments.
• Confident enforcing standards and saying no when an order does not meet requirements.
• Skilled at balancing patient experience, operational flow, and regulatory discipline without allowing accountability to diffuse.
• Experienced in building structure, visibility, and control in environments with inconsistent processes or rapid growth.
  
  

Education Requirements

• Bachelor’s degree in healthcare administration, nursing, business, public health, or a related field preferred.
• Equivalent combination of education and relevant healthcare operations or compliance leadership experience may be considered.