Director Stars & Member Experience

Presbyterian Healthcare Services

7d•Hybrid

About The Position

The Director, Stars & Member Experience provides strategic leadership for Presbyterian Health Plan's Medicare Star Ratings, CAHPS, Health Outcomes Survey (HOS), and Member Experience programs. This position is responsible for leading the Star program and developing and executing enterprise strategies that improve member experience, quality outcomes, and financial performance while supporting the organization's strategic and regulatory objectives. The Director leads the Member Experience Program and serves as the organization's primary expert in member experience strategy and customer insights across all LOBs as well as the Medicare Stars program. Through influence and collaboration, this leader promotes a member-centered culture and ensures that the voice of the member is incorporated into organizational decision-making, program design, quality initiatives, and operational strategies. This role is accountable for Medicare Star Ratings performance, CAHPS and HOS outcomes, member experience measurement, survey administration, vendor oversight, and enterprise-wide improvement efforts designed to achieve exceptional member experiences and quality results.

Requirements

Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Marketing, Customer Experience, or related field required
7+ years of progressive leadership experience in healthcare quality, member experience, Medicare Advantage, population health, or managed care.
Minimum 3 years leading teams and cross-functional initiatives.
Experience developing strategic improvement programs and influencing executive stakeholders.
Medicare Stars expertise
Member experience and customer journey design
CAHPS and HOS strategy
Quality improvement methodology
Healthcare analytics and performance management
Executive communication and influence
Strategic planning
Cross-functional leadership
Change management

Nice To Haves

Master's degree preferred.
Customer Experience certification, CPHQ, or related certification preferred.
Demonstrated success improving Medicare Stars, CAHPS, HOS, and consumer experience measures.
Healthcare, health plan, or managed care experience strongly preferred.
Experience in project management, process improvement, and organizational change leadership preferred.

Responsibilities

Develop and execute the organization's Medicare Stars strategy to achieve annual quality and financial performance goals.
Lead enterprise efforts to improve Star Ratings, CAHPS results, HOS outcomes, and member satisfaction.
Establish governance structures, performance goals, and accountability frameworks for Stars-related initiatives.
Monitor performance trends and identify opportunities to improve clinical quality, member experience, and operational effectiveness in collaboration with Quality Performance Improvement team and the HEDIS operations team.
Partner with Population Health, Behavioral Health, Risk Adjustment, Provider Relations, Customer Service, Network Management, and Care Management teams to improve performance outcomes.
Lead the design and implementation of member-centric experiences across the organization.
Identify strategic opportunities to improve the member journey and collaborate with stakeholders to redesign processes and services.
Promote a culture where member impact is a key consideration in organizational decision-making.
Stay current on emerging customer experience methodologies, best practices, and industry trends.
Translate member insights into actionable recommendations for business leaders.
Analyze member feedback, survey results, complaints, grievances, and operational data to identify trends and improvement opportunities.
Develop a deep understanding of member needs, expectations, motivations, and barriers through research and data analysis.
Oversee administration of member experience measurement programs, including CAHPS, HOS, satisfaction surveys, and other voice-of-customer tools.
Recommend strategic priorities and improvement initiatives designed to strengthen member satisfaction and quality outcomes.
Anticipate risks that may impact organizational performance and proactively escalate concerns and recommended actions.
Present performance reports and strategic recommendations to executive leadership, quality committees, and governing bodies.
Lead enterprise-wide improvement initiatives focused on member experience and quality performance.
Ensure improvement efforts are supported by appropriate methodologies, documentation, tracking, and alignment with organizational strategic goals.
Partner with operational leaders to implement targeted interventions that improve survey performance and member outcomes.
Evaluate effectiveness of initiatives and communicate progress, outcomes, and lessons learned.
Define key performance indicators that measure what matters most to members.
Develop executive dashboards and board-level metrics related to Stars, CAHPS, HOS, and member experience.
Establish performance monitoring and reporting processes that drive accountability and transparency.
Communicate insights, trends, opportunities, and performance results across the organization.
Recommend innovative approaches that improve engagement, satisfaction, access, outcomes, and retention.
Evaluate program effectiveness and support the development of future strategies and investments.
Oversee vendors supporting member experience, CAHPS, HOS, outreach, and engagement activities.
Monitor vendor performance and ensure contractual expectations and quality outcomes are achieved.
Ensure effective administration of survey activities and member engagement efforts.