Director, Stars Operations

SCAN Health Insurance•Long Beach, CA

1d•Remote

About The Position

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve. The Director, Stars Ops will lead and integrate STARS Rx Operations, HEDIS vendor wrap-around services, and performance management to drive sustainable improvement in STARS ratings. Serve as a key partner to Quality, Clinical, Pharmacy, Network, and Vendor teams to align execution with enterprise quality goals

Requirements

Bachelor’s Degree or equivalent experience.
7+ years of experience in a Medicare managed care or provider organization.
7+ years of experience in Medicare Star rating program.
Leadership - Skilled to develops others
Business Insight - In-Depth understanding of the business
Problem Solving - Good problem-solving skills
Strategic Mindset - Creates strategies to sustain competitive advantage
Strong verbal and written communication skills.
Ability to analyze and synthesize complex information.
Excellent organizational, decision-making, and multi-tasking skills.
Ability to prioritize multiple and competing tasks, work independently and in a team environment.
Proficient in MS Office

Nice To Haves

Graduate or Advanced Degree or equivalent experience preferred.

Responsibilities

Own overall STARS operational strategy and execution across medical and pharmacy domains.
Provide direct leadership and oversight of STARS Rx Operations, ensuring alignment with CMS requirements and quality improvement priorities.
Translate STARS and HEDIS requirements into actionable operational plans with clear accountability.
Lead HEDIS vendor wrap-around services, including oversight of supplemental data, chart retrieval, abstraction, and validation processes.
Establish strong governance, performance expectations, and accountability with external vendors.
Monitor vendor performance against SLAs, quality benchmarks, and timelines, and implement corrective actions as needed.
Drive performance management processes to track Rx Ops & HEDIS measure performance, trends, risks, and opportunities.
Partner with analytics teams to ensure timely, accurate reporting and actionable insights.
Develop and maintain dashboards, scorecards, and executive-level reporting for quality outcomes.
Partner with Medical Groups and IT to operationalize the quality technology stack supporting STARS Rx and HEDIS, enabling actionable reporting, gap identification, and performance improvement at the provider and member level.
Lead initiatives to improve measure performance, close gaps in care, and optimize member and provider engagement strategies.
Identify root causes of underperformance and implement sustainable corrective and preventive actions.
Ensure continuous readiness for audits, data validation, and CMS reviews.
Partner closely with Clinical, Pharmacy, Network, Operations, Compliance, and IT teams to drive integrated STARS execution.
Influence and align senior leaders and stakeholders around quality priorities and operational trade-offs.
Act as a subject matter expert and thought leader for STARS operations and quality performance.
Ensure compliance with CMS, NCQA, and regulatory requirements related to STARS, HEDIS, and pharmacy measures.
Proactively identify operational and regulatory risks and implement mitigation strategies.
Support internal and external audits and regulatory inquiries.
Lead, coach, and develop high-performing teams responsible for STARS operations and vendor oversight.
Foster a culture of accountability, transparency, and continuous improvement.
Drive change management efforts to support new initiatives, regulatory updates, and evolving quality strategies.
Develop and execute strategies to meet and exceed Medicare Stars performance targets.
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 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.
Foster a culture of continuous improvement and accountability across teams.
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.
Serve as the primary liaison between vendors and internal stakeholders, promoting collaboration and alignment.
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.
Lead or participate in workgroups to address system-wide challenges affecting Stars performance.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base salary range: $147,900 to $214,030 per year
Internal title - Dir Star Quality Program
Work Mode - Remote
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!
A competitive compensation and benefits program;
An annual employee bonus program;
Generous paid-time-off (PTO);
Eleven paid holidays per year;
Excellent Retirement Savings program;
A work-life balance;
An opportunity to become part of a team that makes a difference to our members and our community every day!