VP, Quality and Stars Strategy

Lumeris•St. Louis, MO

1d•Onsite

About The Position

As our VP of Quality and Stars Strategy you will set the enterprise-wide strategic direction for Essence Healthcare’s Quality Strategy, and Medicare Stars (HEDIS) program, driving market-leading performance through sophisticated provider engagement, advanced data analytics, and disciplined cross-functional leadership. We’re looking for a builder. Not someone who inherits a strategy and maintains it — someone who assesses the landscape, architects a plan, and leads an organization through it. You bring experience taking ownership of a Stars program, identifying where to focus resources for maximum rating and revenue impact, and have experience building cross-functional structure, and delivered measurable results. And you lead accordingly — through influence, partnership, and a clear strategic narrative, not by doing the work alone.

Requirements

Bachelor’s degree is required.
Candidates must meet one of the following advanced qualifications: A Bachelor’s degree in Nursing or a related clinical field; OR A Master’s degree in Health Administration (MHA), Business Administration (MBA), or Public Health (MPH).
A minimum of 8 years of executive-level leadership experience within managed care, with a deep and specific focus on Quality Programming and CMS Stars.
Proven track record of developing and executing strategies that resulted in a measurable improvement in a health plan's Star rating (e.g., achieving or maintaining a 4+ Star rating).
Expert-level understanding of all Stars domains, including HEDIS, CAHPS, Part D measures, and member experience components, as well as their complex interactions.
Demonstrated experience managing "teams of teams" and a proven ability to oversee, coach, and develop other leaders in a complex, matrixed environment.
Exemplary business acumen, executive presence, and the ability to serve as an internal and external spokesperson in formal and informal settings.
Highly skilled at building strategic relationships and collaborating effectively with senior executives and provider leaders.
Exceptional ability to analyze, interpret, and communicate complex data to diverse audiences to inform strategy and influence action.

Nice To Haves

CPHQ Certification.

Responsibilities

Architect, own, and continuously refine a multi-year, enterprise-wide strategic roadmap to achieve and sustain a top-tier (4.0+) CMS Star rating. This includes translating complex CMS technical specifications into an actionable, multi-faceted Stars workplan.
Serve as the ultimate accountable executive for all enterprise-wide Stars outcomes, establishing clear KPIs and reporting progress directly to the executive leadership team and Board of Directors.
Act as the company's national subject matter expert and primary spokesperson on Stars. Clearly articulate the "why" behind the strategy and performance results in high-stakes settings, including executive steering committees, internal town halls, and external industry conferences.
Proactively monitor the competitive landscape and CMS regulatory changes to anticipate market trends, identify emerging risks, and ensure the company's strategy remains agile and ahead of the curve.
Oversee the budget and resource allocation for all Stars-related initiatives, ensuring investments are prioritized for maximum impact and ROI.
Function as the executive liaison to our provider partners, strengthening the relationship as a true partnership focused on mutual success in value-based care.
Establish and lead joint quality committees and regular performance reviews with key provider groups to embed Stars accountability, share best practices, and collaboratively address performance gaps.
Develop and deploy sophisticated provider-facing analytics, performance dashboards, and best-practice toolkits to empower our partners with the data they need to improve patient outcomes.
Partner with network management to inform the design of provider-facing programs and incentives that directly align with and drive top-tier Stars performance.
Champion a culture of relentless, data-driven performance improvement. Move beyond simple reporting to deep-dive analytics, root cause analysis, and the identification of member and provider abrasion points that impact results.
Partner with Business Intelligence and Analytics leaders to guide the development of predictive models that identify members at risk for non-adherence or gaps in care, allowing for proactive intervention.
Translate vast amounts of data (clinical, claims, pharmacy, member experience) into a clear, compelling narrative that informs executive-level strategy and guides operational priorities.
Lead through influence and collaboration across the executive team, ensuring tight alignment and coordinated execution between Clinical, Pharmacy, Marketing, Operations, and Compliance Departments.
Oversee, coach, mentor, and develop a high-performing team of leaders ("teams of teams") responsible for HEDIS operations, quality analytics, and direct provider quality support.
Collaborate directly with the Chief Compliance Officer to ensure all Stars and HEDIS activities not only meet but exceed CMS guidelines, fostering a culture of proactive compliance.