Sr. Director, Clinical Quality - Medicare Stars

Your Role 

Reporting to the Vice President, Quality, the Senior Director, Quality - Medicare STARs is a senior leader with expertise in developing STARs strategy, short- and long-term STARs initiatives, and oversight of STARs performance. The position will have responsibility for STARs quality improvement and performance for all lines of business with Medicare plans. You will serve as a strategic leader to develop, implement, and maintain the enterprise STAR quality improvement program in alignment with the overall Quality Roadmap and plan to achieve desired outcomes for members and on the overall impact of STARs performance for the organization at large.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• In partnership with the Vice President, Quality, serve as the accountable leader for Medicare Stars and HEDIS performance, including overall Star Ratings, measure-level outcomes, quality performance, and associated financial results.
• Develop and lead the enterprise Medicare Stars strategy, translating organizational objectives, CMS requirements, and market dynamics into annual and multi-year priorities.
• Serve as the organization's subject matter expert on Medicare Stars methodology, CMS specifications, measure weighting, cut points, improvement methodology, and rating calculations, ensuring strategic decisions are aligned to program requirements and future performance opportunities.
• Establish and lead enterprise Medicare Stars governance, accountability, reporting, and escalation processes to ensure consistent ownership and execution across the organization.
• Define performance expectations and accountability for Medicare Stars and HEDIS measures across business units, operational departments, providers, and vendor partners.
• Influence and align leaders across Market, Clinical Operations, Provider Performance, Network Management, Pharmacy, Analytics, Member Experience, Operations, and other key functions to drive enterprise ownership of Stars outcomes.
• Lead provider engagement and performance improvement strategies, including provider incentives, quality-focused value-based arrangements, provider education, and performance transparency initiatives.
• Drive member engagement, preventive care, health equity, and member experience strategies to improve measure performance, close care gaps, and enhance overall Stars results.
• Foster an enterprise culture of accountability and quality excellence, ensuring Medicare Stars performance is understood and owned throughout the organization.
• Accountable for Medicare HEDIS performance, including overall quality results, measure-level outcomes, annual improvement targets, and regulatory performance.
• Ensure enterprise-wide compliance with CMS, NCQA, DMHC, and other applicable regulatory, accreditation, and reporting requirements.
• Evaluate and communicate Medicare Stars performance, risks, opportunities, financial implications, and strategic recommendations to executive leadership, quality committees, and governing bodies.
• Serve as a trusted strategic advisor to executive leadership on Medicare quality strategy, Stars methodology, regulatory requirements, emerging trends, and organizational readiness priorities.
• Lead Medicare Stars forecasting, scenario modeling, performance monitoring, root cause analyses, and recovery strategies to proactively manage performance risk and maximize Star Rating outcomes. 

Your Knowledge and Experience 

• Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree.    
• Master’s degree in relevant field (e.g. MHA, MBA, MPH or similar) is preferred.    
• 12 years prior relevant experience is required.
• 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports is required.        
• Expert knowledge of Medicare STARs required.                
• Previous experience leading quality and performance improvement for a health plan.

Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.