Director, Clinical Quality
Blue Shield of California • Woodland Hills, CA4d • Hybrid
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Director, Clinical Quality (Medicare Stars)
Blue Shield of California•Woodland Hills, CA
•Hybrid
About The Position
The Director of Clinical Quality - Medicare Stars reports to the Senior Director of Clinical Quality and leads the organization’s Medicare Stars HEDIS strategy, execution, and performance oversight. The role is critical to maintaining and improving Medicare Star Ratings and HEDIS performance through initiatives focused on closing clinical gaps, quality improvement, health outcomes, and member experience. The Director oversees the clinical quality strategic roadmap, operational excellence, and performance across multiple H-Contracts and future Medicare Advantage contracts. The position calls for a leader with deep expertise in Stars, HEDIS, and quality improvement methodologies who can collaborate across clinical and operational functions to improve performance and drive systemic change. The organization’s leadership model emphasizes developing leaders, creating opportunities for growth, building high-performing teams, getting results responsibly, and fostering continuous learning. This is a hybrid role. Employees are expected to work in the office according to the hybrid workplace model, which for most teams means two days each week. Employees who live more than 50 miles from an office location will determine in-office time with their manager based on business need.
Requirements
- Bachelor’s degree, or a high school diploma/GED with four additional years of relevant experience in lieu of a degree.
- 10 years of healthcare experience leading large-scale, cross-functional programs focused on quality improvement.
- 6 years of prior people-management experience, with direct responsibility for supervising, coaching, and evaluating direct reports.
- 6 years of direct experience managing Stars and HEDIS performance initiatives, with demonstrated success driving improvements.
- Ability to interpret complex healthcare data, develop insights, and apply analytics-driven strategies.
- Experience with Medicare Advantage quality programs, CMS requirements, and Stars and HEDIS performance-improvement techniques.
- Strong communication skills and the ability to engage effectively with executive leadership, providers, and stakeholders.
- Strong project-management skills, including the ability to meet tight deadlines, manage competing priorities, and lead strategic initiatives.
Nice To Haves
- Master’s degree in Public Health (MPH), Healthcare Administration (MHA), or a related field.
Responsibilities
- Lead the enterprise-wide Medicare Stars HEDIS improvement strategy, aligning it with the Quality Roadmap and company goals.
- Develop and implement targeted interventions to address gaps in care and improve Stars and HEDIS performance across populations.
- Oversee operational processes and ensure clinical, data, and outreach teams are equipped to execute HEDIS Stars initiatives.
- Collaborate with internal teams and external partners, including providers, vendors, and regulatory agencies, to streamline quality initiatives and advance healthcare equity efforts.
- Maintain reporting dashboards to monitor HEDIS Stars metrics, identify improvement opportunities, and strengthen organizational accountability.
- Lead test-and-learn initiatives and use analytical insights to optimize Stars performance.
- Design and implement strategies to improve Medicare member engagement, experience, and satisfaction through quality healthcare interventions.
- Oversee Stars and HEDIS vendor relationships, operational budgets, and project and program management.
- Lead and develop a high-performing team, fostering continuous learning, innovation, and accountability in Stars and HEDIS operations.
- Serve as a subject matter expert on Medicare Stars Ratings, HEDIS measures, and quality performance.
- Ensure compliance with CMS regulations and keep the organization informed of industry best practices.
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What This Job Offers
Job Type
Full-time
Career Level
Director
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