Population Health Director

Adobe Care And Wellness LLC•Phoenix, AZ

18d•Hybrid

About The Position

The Director of Population Health is a senior leadership role responsible for overseeing population health programs, community-based care coordination, and clinical quality performance with a primary focus on improving HEDIS and Medicare STARS outcomes. This role bridges operational execution and quality performance strategy by translating organizational goals into actionable workflows, performance improvement initiatives, and frontline care delivery standards. The Director is accountable for leading HEDIS/STARS-focused Quality Improvement initiatives, optimizing care coordination operations, supporting utilization reduction strategies, and ensuring compliance with NCQA, URAC, QAPI, and health plan requirements. This role works closely with executive leadership while maintaining direct operational oversight of teams and program performance. This position works closely with our Field Manager and Assistant Director of Community Care Services and reports to our Sr Director of Integrated Care Services. In the Director role, you will be reporting to the Phoenix office (conveniently located off the 51, Glendale Ave. and 16th St.) three days per week with an option to work remotely two days per week. In this role, you may be responsible for traveling throughout the APH-supported states, including but not limited to AZ, LA, NV, NM, and OR

Requirements

Five (5)years of healthcare, population health, or clinical operations experience.
Five (5)years of progressive management experience in quality improvement, population health, or care coordination.
Demonstrated experience improving HEDIS and Medicare STARS performance.
Strong understanding of Medicare Advantage, Medicaid, and value-based care models.
Experience managing multidisciplinary teams across multiple states or regions.
Strong analytical and operational problem-solving skills.
Excellent communication, leadership, and stakeholder collaboration skills.
Proficiency with EMR systems (Salesforce preferred) and Microsoft Office Suite.
Ability to manage multiple initiatives in a fast-paced environment.
Willingness to travel as needed
Bachelor’s degree required (healthcare administration, nursing, public health, social work or related field).

Nice To Haves

Master’s degree preferred (MSN, MHA, MPH, MBA, MSW).
CPHQ or CCM certification preferred.
Project Management certification a plus.

Responsibilities

Provide senior management leadership for population health programs and care coordination operations.
Implement organizational population health strategies and translate performance goals into operational execution plans.
Collaborate with Quality, Compliance, Analytics, and Operations teams to support organizational performance targets.
Participate in health plan performance meetings and quality improvement discussions.
Support program redesign initiatives to align workflows with evolving payer and regulatory requirements.
Lead the design and execution of Quality Improvement initiatives focused on improving HEDIS and Medicare STARS scores.
Develop annual HEDIS/STARS operational workplans and intervention strategies.
Monitor measure performance trends and identify priority opportunities for gap closure.
Partner with frontline teams to operationalize outreach strategies, documentation standards, and quality workflows.
Oversee real-time performance tracking and adjust intervention strategies throughout the measurement year.
Support supplemental data submissions, medical record retrieval efforts, and audit readiness activities.
Ensure staff education remains aligned with current HEDIS technical specifications and CMS STARS requirements.
Provide direct operational oversight of community-based care coordination teams including care coordinators, navigators, transition specialists, and field staff.
Ensure consistent delivery of high-quality in-home and community-based services that support quality and utilization performance goals.
Support Assistant Directors and field leadership with staffing models, productivity expectations, and performance coaching.
Address escalated member care issues, transition of care challenges, and SDOH barriers impacting outcomes.
Standardize workflows that align care coordination activities with quality improvement priorities.
Monitor utilization trends including inpatient admissions, ED visits, and readmissions.
Implement targeted interventions to reduce avoidable utilization while maintaining quality standards.
Support Health Benefit Ratio (HBR) improvement through population health initiatives and care coordination strategies.
Assist with business case development for new programs and payer initiatives.
Use claims, clinical, and operational data to identify improvement opportunities.
Oversee dashboards tracking HEDIS, STARS, utilization, productivity, and quality outcomes.
Translate data insights into operational improvement actions.
Lead recruitment, onboarding, training, and ongoing development of management and frontline staff.
Promote accountability, performance excellence, and continuous improvement across teams.
Conduct leadership meetings and provide routine performance coaching.
Support development and enforcement of clinical and quality-related policies and procedures.
Collaborate with internal departments including Quality, Compliance, Data Analytics, Provider Relations, and Operations.
Coordinate with external provider partners and community organizations to support quality improvement and care gap closure initiatives.
Support accreditation and audit activities as needed.
Other duties as assigned by management.