Director Clinical Quality Performance & Improvement

Cambia Health Solutions • Portland, OR

1d • $163,200 - $220,800 • Hybrid

About The Position

Director, Clinical Quality Performance and Improvement Oregon, Washington, Idaho or Utah (Hybrid) Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team is living our mission to make health care easier and lives better. As a member of the Enterprise Quality team, our Director, Clinical Quality Performance and Improvement leads the execution of the enterprise Medicare Stars strategy, driving sustained performance improvement through targeted initiatives, robust analytics, and cross-functional collaboration. This role translates strategic priorities into actionable plans, establishes the operational infrastructure needed to achieve Stars goals, and ensures the organization has the measure-level insights and program management capabilities required for success- all in service of creating an economically sustainable health care system. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us. Are you a Stars expert with a proven track record improving Medicare Stars ratings through data-driven initiatives and cross-functional collaboration? Then this role may be the perfect fit. Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Requirements

• Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or related field, Master's degree (MBA, MHA, MPH, or related) strongly preferred.
• 12+ years of progressive healthcare quality or performance improvement experience including 8+ years of direct Medicare Stars program experience, including measure-level performance improvement and CMS reporting.
• 5+ years of people leadership experience with demonstrated success building and developing quality teams or equivalent combination of education and experience.
• Medicare Advantage Expertise : Proven track record improving Stars ratings through data-driven initiatives, with deep knowledge of CMS methodology, measure specifications, and Part D requirements
• Stars Performance Management: Experience implementing Stars-specific interventions including gaps in care programs, medication adherence initiatives, and member experience improvements
• Advanced Analytics & Forecasting: Strong proficiency in performance analytics, statistical forecasting, predictive modeling, and BI tools (Tableau, Power BI) for dashboard development
• Healthcare Quality Standards: Solid understanding of NCQA HEDIS measures, risk adjustment models, value-based care, and population health management principles
• Process Improvement Methodology: Knowledge of Lean, Six Sigma, PDSA, or similar improvement frameworks to drive systematic quality enhancements
• Cross-Functional Leadership: Ability to influence and drive results in matrix environments, building trusted partnerships with clinical, operational, and technical stakeholders without direct authority
• Strategic Communication: Exceptional skills translating complex data into actionable insights and presenting technical content to diverse audiences, with demonstrated ability to leverage AI tools for efficiency and innovation.

Nice To Haves

• CPHQ, Lean Six Sigma Green Belt or Black Belt, or PMP preferred

Responsibilities

• Lead annual and multi-year Medicare Stars strategy development, translating priorities into detailed operational plans while monitoring CMS rulemaking and providing leadership recommendations on program implications
• Serve as organizational expert on Medicare Stars requirements, measure specifications, and CMS methodology, ensuring enterprise-wide understanding of priorities and cascading goals across cross-functional teams
• Lead Stars analytics operations including measure-level tracking, forecasting models, root cause analysis, and financial impact assessments
• Deliver actionable performance insights through deep-dive analyses of underperforming measures, trend identification, and executive-level reporting to drive quality improvements
• Drive cross-functional Stars improvement initiatives by partnering with clinical operations, care management, pharmacy, provider relations, and operational leaders to implement and scale interventions
• Facilitate Stars governance and technical operations including workstream coordination within enterprise quality structure, HEDIS engine optimization, data validation, and vendor management collaboration
• Lead Stars Program operations and improvement initiatives by directing team priorities, overseeing quality improvement projects using Lean/Six Sigma methodologies, and maintaining real-time performance dashboards
• Manage Stars reporting and compliance including executive presentations, quarterly business reviews, regulatory submissions, CMS reporting, data audits, and timely submission requirements
• Lead and develop Stars program team by mentoring specialists and analysts in Medicare quality measurement, setting performance expectations, providing coaching and evaluations, and building team capacity to manage priorities and adapt to evolving CMS requirements

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 1,001-5,000 employees