Director, Medicare Stars

Inland Empire Health Plan•Rancho Cucamonga, CA

1d•$169,312 - $232,794•Hybrid

About The Position

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to the Chief Quality Officer, the Director of Medicare Stars is responsible for leading the strategic direction, execution, regulatory compliance, and continuous performance improvement of the Medicare Star Ratings program at IEHP. This role will oversee enterprise-wide cross-functional initiatives to drive quality outcomes, enhance member experience, and ensure compliance with the Center of Medicare & Medicaid Services (CMS) Star Ratings requirements. The Director develops and implements data-driven strategies that improve performance across all Star measures in collaboration with clinical, operational, IT, and analytics team. By providing strategic oversight, fostering cross-functional collaboration, and leveraging data-driven insights, the Director will ensure IEHP not only meets, but exceeds CMS expectations enhancing quality outcomes, member experience, plan reputation, financial incentives, and driving sustainable growth. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Requirements

Seven (7) years of progressive experience in Medicare Advantage, quality improvement in a health plan setting or health plan operations. Three (3) years of leadership experience managing teams or large-scale cross-functional initiatives. Proven track record of driving performance improvement and achieving quality benchmarks
Bachelor’s degree in Health Administration, Public Health, Business Administration, or a related field from an accredited institution required
Valid California Driver’s License preferred
Expert comprehensive knowledge of CMS Star Ratings, HEDIS, CAHPS, HOS, and related quality measures for health plans
Excellent communication, presentation, executive presence, interpersonal, and relationship building skills. Excellent analytical, critical thinking, problem-solving skills and experience with data tools (e.g., Power BI, Tableau, SAS, SQL)
Collaborative leader with ability to drive influence across the organization. Strategic thinker with strong business acumen. Data-driven and outcomes-focused

Nice To Haves

Proven track record of improving Star Ratings performance preferred. Experience working with NCQA, CMS audits, or Medicare Advantage plan operations preferred
Master’s Degree (MPH, MHA, MBA, or related) from an accredited institution preferred

Responsibilities

Lead the strategic planning and execution of the Medicare Stars strategy to achieve and sustain 4+ Star Ratings across all domains
Oversee the design, implementation, and evaluation of enterprise-wide quality improvement initiatives aligned with CMS Star Ratings and associated measures
Direct cross-functional collaboration with internal stakeholders (e.g., Quality, Pharmacy, Provider Relations, Member Services, IT, and Compliance) to drive integrated performance improvement strategies
Monitor and interpret Star Ratings performance data, trends, and CMS cut points, and regulatory trends to proactively identify risks and opportunities
Develop predictive models and dashboards in collaboration with analytics teams to forecast performance and guide interventions
Serve as the organizational subject matter expert on CMS Star Ratings methodology, regulatory updates, and technical specifications; ensure timely dissemination of updates and compliance
Lead the development of executive-level presentations, strategic recommendations, and performance briefings for senior leadership and governance bodies
Champion a culture of quality, accountability, and continuous improvement across the organization
Manage and mentor a team of professionals, fostering growth and alignment with organizational goals. Conduct performance reviews of each Team Member within IEHP guidelines
Perform any other duties as required to ensure Health Plan operations and department business needs are successful