Director of Quality -Medicare Advantage (MA Stars)

Baylor Scott & White Health • Temple, TX

131d

About The Position

The Director of Quality for MA Stars will lead strategic initiatives to achieve and sustain exceptional Medicare Advantage Star Ratings performance across the health plan. This role is responsible for developing and executing quality improvement programs, collaborating with cross-functional teams, leading vendor partnerships, member satisfaction, and ensuring compliance with CMS and regulatory requirements. The ideal candidate will bring deep expertise in MA Stars, HEDIS, CAHPS, and HOS metrics, and a proven track record of driving measurable improvements in quality outcomes.

Requirements

• Bachelor's degree in healthcare administration, public health, nursing, or related field (Master's preferred).
• Minimum of 7 years (preferred) of experience in healthcare quality, with at least 3 years focused on Medicare Advantage Stars.
• Strong knowledge of CMS Stars methodology, HEDIS, CAHPS, and HOS.
• Experience with data analytics tools and platforms (e.g., Excel, EPIC, Press Ganey).
• Excellent leadership, communication, and project management skills.
• Strong analytical skills, with ability to interpret and apply complex data sets.
• Excellent organizational, communication, and influence skills.

Nice To Haves

• Master's degree (MPH, MHA, MBA, or equivalent).
• Lean Six Sigma, PMP, or similar project, process improvement certifications.
• RN or clinical background.
• Experience working with health plans or managed care organizations.
• Familiarity with Medicare Advantage benefits and member experience strategies.

Responsibilities

• Develop and execute strategies to meet and exceed Medicare Stars performance targets to achieve and maintain 4+ star ratings.
• Drive improvement in clinical quality metrics, with a focus on Rx adherence measures (statin use, hypertension medication adherence, etc.).
• Monitor regulatory updates and ensure compliance with CMS Star Ratings requirements.
• Analyze performance data and trends for clinical metrics to identify improvement opportunities.
• Collaborate with clinical teams to develop and implement interventions to enhance outcomes.
• Lead efforts to optimize medication adherence programs and support pharmacy-related initiatives.
• Oversee performance tracking and analytics for HEDIS, CAHPS, HOS, and Part D measures.
• Develop dashboards and reporting tools to communicate performance trends to executive leadership.
• Represent the organization in external quality forums and CMS-related engagements.
• Oversee daily operations related to quality initiatives, ensuring seamless execution and alignment with organizational goals.
• Develop processes to streamline workflows, enhance efficiency, and achieve measurable results.
• Manage relationships with external vendors, ensuring contractual obligations and quality deliverables are met.
• Evaluate vendor performance through established metrics and implement corrective actions when necessary.
• Partner with member experience, healthcare services, pharmacy, and IT teams to design and execute initiatives.
• Communicate performance outcomes and improvement plans to executive leadership and stakeholders.
• Serve as a trusted advisor and thought leader to senior executives.
• Identify organizational gaps in resources, infrastructure, or capabilities that impact Stars performance.
• Build business cases for new or enhanced programs and interventions, supported by data-driven justification.
• Drive execution of key Stars initiatives by applying structured project management methodologies.

Benefits

• Eligibility on day 1 for all benefits.
• Dollar-for-dollar 401(k) match, up to 5%.
• Debt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more.
• Immediate access to time off benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Hospitals
• Education Level: Master's degree