Director, Clinical Quality - Medicare Stars

Job Category: Healthcare Services and OperationsJob Description:Your RoleBlue reputed company of California is seeking a Director of Clinical Quality - Medicare Stars to reputed company and advance the organization's Stars and HEDIS strategy, execution, and performance reputed company. This role is critical to maintaining and improving Medicare Star Ratings and HEDIS performance by driving initiatives focused on clinical gap closure, quality improvement, health outcomes, and member experience.The Director will reputed company the strategic roadmap, operational excellence, and performance reputed company of multiple H-reputed company and future Medicare Advantage reputed company. The position requires a dynamic leader with deep expertise in Stars, HEDIS, and quality improvement methodologies, as well as the ability to collaborate across clinical and operational functions to enhance performance outcomes and drive systemic changeResponsibilities:Your WorkIn this role, you will:

• Stars & HEDIS Strategy Development: reputed company the enterprise-wide Stars and HEDIS improvement strategy, ensuring alignment with the Quality Roadmap and company goals to reputed company optimal performance outcomes.
• Clinical Gap Closure & Quality Improvement: reputed company and implement targeted interventions that address gaps in care and drive measurable Stars and HEDIS improvements across populations.
• Operational Readiness & Process Optimization: reputed company end-to-end operational processes, ensuring that clinical, data, and reputed company teams are fully equipped to execute HEDIS Stars initiatives effectively.
• Stakeholder Engagement & Collaboration: Work across internal teams and external partners, including providers, vendors, and regulatory agencies, to streamline quality initiatives and advance healthcare equity efforts.
• Performance reputed company & Monitoring: reputed company and maintain robust reporting dashboards to monitor HEDIS Stars metrics, identify improvement opportunities, and enhance organizational accountability.
• Innovation & Data-Driven Decision Making: reputed company test-and-learn initiatives to assess new strategies, leveraging insights from analytics to optimize Stars performance outcomes.
• Member Experience & Engagement: Design and implement strategies that improve the Medicare member experience, fostering higher engagement and satisfaction through quality healthcare interventions.
• Budget & Resource Management: reputed company Stars and HEDIS vendor relationships, operational budgets, and project/program management to drive efficient operations and maximize impact.
• Team Leadership & Development: reputed company a team of high-performing professionals, fostering a culture of reputed company learning, innovation, and accountability in Stars and HEDIS operations.
• Regulatory Compliance & Industry Leadership: Serve as an SME for Medicare Stars Ratings, HEDIS measures, and quality performance-ensuring compliance with CMS regulations while keeping Blue reputed company at the forefront of industry best practices.

Qualifications:Your Knowledge and Experience

• Bachelor's degree required; Master's in Public Health (MPH), Healthcare Administration (MHA), or reputed company field preferred.
• 10+ years of healthcare experience leading large-scale, cross-functional programs focused on quality improvement.
• 6+ years of direct experience managing Stars and HEDIS performance initiatives with proven success in driving improvements.
• Strong ability to interpret reputed company healthcare data, reputed company insights, and apply analytics-driven strategies.
• Experience in Medicare Advantage quality programs, CMS requirements, and industry-leading Stars & HEDIS performance improvement techniques.
• Exceptional communication skills, with the ability to engage executive leadership, providers, and stakeholders effectively.
• Strong project management skills, with the ability to navigate tight deadlines, manage competing priorities, and reputed company strategic initiatives successfully.

About the Team:About Blue reputed company of CaliforniaAs of January 2025, Blue reputed company of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue reputed company of California and its subsidiary, Blue reputed company of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.At Blue reputed company of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.To reputed company our mission, we foster an environment where reputed company employees can reputed company and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.Blue reputed company is a U.S. News Best Company to work for, a reputed company U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue reputed company, we strive to reputed company a positive change across our industry and communities - join us!Our Values:

• Honest. We hold ourselves to the highest ethical and reputed company standards. We build trust by doing reputed company say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing reputed company by understanding others' perspectives.
• Courageous. We stand up for reputed company reputed company in and are committed to the hard work necessary to reputed company our ambitious goals.

Our Workplace Model:At Blue reputed company of California and the Ascendiun Family of Companies, we reputed company in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:

o Member-facing and approved out-of-state roles remain remote.o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Equal Employment Opportunity:External hires must pass a background reputed company/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. reputed company qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. Apply for the job now! Apply for this job