Director, Clinical Quality (Medicare Stars)
About The Position
The Director, Clinical Quality (Medicare Stars) reports to the Senior Director of Clinical Quality and leads the organization’s Medicare Stars HEDIS strategy, execution, and performance oversight. The role is responsible for maintaining and improving Medicare Star Ratings and HEDIS performance through initiatives focused on closing clinical gaps, quality improvement, health outcomes, and member experience. The Director oversees the clinical quality strategic roadmap, operational excellence, and performance oversight across multiple H-Contracts and future Medicare Advantage contracts. The role collaborates across clinical and operational functions to improve performance outcomes and drive systemic change, while leading and developing a high-performing team. It also serves as a subject matter expert on Medicare Stars Ratings, HEDIS measures, and quality performance, ensuring compliance with CMS regulations and alignment with industry best practices. The position follows a hybrid workplace model. For most teams, this means working in the office two days each week. Employees living more than 50 miles from an office location will determine in-office time with their manager based on business need. The role is based in office and work-from-home office/deskwork environments, with a sedentary activity level for most of the workday.
Requirements
- Bachelor’s degree, or a high school diploma/GED and four years of additional relevant experience in lieu of a degree.
- At least 10 years of healthcare experience leading large-scale, cross-functional programs focused on quality improvement.
- At least 6 years of people management experience, including supervising, coaching, and evaluating direct reports.
- At least 6 years of direct experience managing Stars and HEDIS performance initiatives, with proven success driving improvements.
- Ability to interpret complex healthcare data, develop insights, and apply analytics-driven strategies.
- Experience in Medicare Advantage quality programs, CMS requirements, and Stars and HEDIS performance improvement techniques.
- Exceptional communication skills and ability to engage executive leadership, providers, and stakeholders.
- Strong project management skills, including navigating tight deadlines, managing competing priorities, and leading strategic initiatives.
Nice To Haves
- Master’s degree in Public Health (MPH), Healthcare Administration (MHA), or a related field.
Responsibilities
- Lead the enterprise-wide Medicare Stars HEDIS improvement strategy, aligning it with the Quality Roadmap and company goals.
- Develop and implement targeted interventions to address gaps in care and improve Stars and HEDIS performance across populations.
- Oversee operational processes and ensure clinical, data, and outreach teams are equipped to execute HEDIS Stars initiatives.
- Work with internal teams and external partners, including providers, vendors, and regulatory agencies, to streamline quality initiatives and advance healthcare equity efforts.
- Maintain reporting dashboards to monitor HEDIS Stars metrics, identify improvement opportunities, and improve organizational accountability.
- Lead test-and-learn initiatives, using analytics insights to optimize Stars performance.
- Design and implement strategies to improve Medicare member engagement, experience, and satisfaction through quality healthcare interventions.
- Oversee Stars and HEDIS vendor relationships, operational budgets, and project and program management.
- Lead and develop a high-performing team, fostering continuous learning, innovation, and accountability in Stars and HEDIS operations.
- Serve as a subject matter expert on Medicare Stars Ratings, HEDIS measures, and quality performance, ensuring CMS compliance and alignment with industry best practices.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
